What the FDA labels say about taking them together
Levomilnacipran and methylene blue
Levomilnacipran's FDA label of April 30, 2024 names methylene blue in its contraindications section; methylene blue's label does not name levomilnacipran itself but warns about its class (SNRIs (serotonin and norepinephrine reuptake inhibitors)). The levomilnacipran label: “Concomitant use of SSRIs and SNRIs including FETZIMA with MAOIs increases the risk of serotonin syndrome.”
Check it at the source: the levomilnacipran FDA label on DailyMed (effective April 30, 2024, Allergan, Inc.); the methylene blue FDA label on DailyMed (effective May 28, 2025, American Regent, Inc.).
What does the levomilnacipran label say about methylene blue?
Levomilnacipran label, contraindicationsStarting FETZIMA in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome [see Dosage and Administration ( 2.6 ) and Warnings and Precautions ( 5.2 )].
Levomilnacipran label, drug interactionsMonoamine Oxidase Inhibitors (MAOIs) Clinical Impact: Concomitant use of SSRIs and SNRIs including FETZIMA with MAOIs increases the risk of serotonin syndrome. … intended to treat psychiatric disorders In a patient who is being treated with linezolid or intravenous methylene blue [see Dosage and Administration (,), Contraindications (), and Warnings and Precautions ()]. Examples: selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue
Levomilnacipran label, warnings and precautionsIf it is necessary to initiate treatment with a MAOI such as linezolid or intravenous methylene blue in a patient taking FETZIMA, discontinue FETZIMA before initiating treatment with the MAOI [see Dosage and Administration ( 2.5 , 2.6 ) and Contraindications ( 4 ), Drug Interactions ( 7.1 )].
Source: FDA drug label (Fetzima), NDA204168 (Abbvie), as published by Allergan, Inc., effective April 30, 2024 (SPL set f371258d-91b3-4b6a-ac99-434a1964c3af), via openFDA; the full label on DailyMed
What does the methylene blue label say about levomilnacipran?
Methylene blue's label does not name levomilnacipran itself; it warns about its class (SNRIs (serotonin and norepinephrine reuptake inhibitors)):
Methylene blue label, drug interactionsAvoid concomitant use of PROVAYBLUE with medicinal products that enhance serotonergic transmission including antidepressants like SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), MAOIs (monoamine oxidase inhibitors), bupropion, buspirone, clomipramine, mirtazapine, linezolid, opioids, and dextromethorphan because of the potential for serious CNS reactions, including potentially fatal serotonin syndrome.
Methylene blue label, boxed warningAvoid concomitant use of PROVAYBLUE with selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs) and opioids. [see Warnings and Precautions ( 5.1 ) and Drug Interactions ( 7.1 )].
Source: FDA drug label (PROVAYBLUE), NDA204630 (Provepharm Sas), as published by American Regent, Inc., effective May 28, 2025 (SPL set 4f6848e5-35ed-4046-b13c-3032b5ba3232), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Levomilnacipran | Methylene blue | |
|---|---|---|
| Labeled for | Depression | n/a |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | $17.61 per unit 20-40 mg titration pak | n/a |
| Shortage now | No current entry | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once