Drug General Information (ID: DDINA2B68Q)
Drug Name			Cocaine (nasal)		Drug Info		Methylene blue		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anesthetics				Antidotes/Mao Inhibitors
Structure

Mechanism of Cocaine (nasal)-Methylene blue Interaction (Severity Level: Major)
Additive hypertensive effects Click to Show/Hide Mechanism Graph
Drug Name		Cocaine (nasal)				Methylene blue
Mechanism 1		Hypertensive effects				Hypertensive effects
Key Mechanism Factor 1
		Factor Name		Hypertensive effects
		Factor Description		Hypertension is defined as a blood pressure reading above a prescribed limit (130/90 mmHg). Most people with hypertension have no signs or symptoms; others may experience: severe headache, shortness of breath, nosebleeds, severe anxiety, and feeling a tingling sensation in the neck or head.
Mechanism Description		Additive hypertensive effects by the combination of Cocaine (nasal) and Methylene blue
Increased risk of hyperpyrexia Click to Show/Hide Mechanism Graph
Drug Name		Cocaine (nasal)				Methylene blue
Mechanism 2		Hyperpyrexia				Hyperpyrexia
Key Mechanism Factor 2
		Factor Name		Hyperpyrexia
		Factor Description		Hyperthermia is an extreme, life-threatening increase in core body temperature. If hyperthermia persists for a long time or worsens, more serious symptoms may occur, such as confusion, headache, constricted pupils, vomiting, diarrhea, and decreased urine output.
Mechanism Description		Increased risk of hyperpyrexia by the combination of Cocaine (nasal) and Methylene blue

Recommended Action
Management		In general, indirect-acting sympathomimetic agents such as cocaine should not be used concurrently with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). At least 14 days should elapse between discontinuation of MAOI therapy and initiation of treatment with sympathomimetic agents.

References
1	Product Information. Cocaine Hydrochloride Nasal (cocaine nasal). Genus Lifesciences Inc., Allentown, PA.
2	Product Information. Nardil (phenelzine). Parke-Dvis, Morris Plains, NJ.
3	Tordoff SG, Stubbing JF, Linter SP "Delayed excitatory reaction following interaction of cocaine and monoamine oxidase inhibitor (phenelzine)." Br J Anaesth 66 (1991): 516-8. [PMID: 2025483]