What the FDA labels say about taking them together
Methylene blue and milnacipran
Milnacipran's FDA label of September 10, 2025 names methylene blue in its contraindications section; methylene blue's label does not name milnacipran itself but warns about its class (SNRIs (serotonin and norepinephrine reuptake inhibitors)). The milnacipran label: “Starting SAVELLA 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.”
Check it at the source: the methylene blue FDA label on DailyMed (effective May 28, 2025, American Regent, Inc.); the milnacipran FDA label on DailyMed (effective September 10, 2025, Allergan, Inc.).
What does the methylene blue label say about milnacipran?
Methylene blue's label does not name milnacipran 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
What does the milnacipran label say about methylene blue?
Milnacipran label, contraindicationsStarting SAVELLA 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 ), Warnings and Precautions ( 5.2 )].
Milnacipran label, drug interactionsIf it is necessary to initiate treatment with a MAOI such as linezolid or intravenous methylene blue in a patient taking SAVELLA, discontinue SAVELLA before initiating treatment with the MAOI [see Dosage and Administration ( 2.5 , 2.6 ), Contraindications ( 4 ), Drug Interactions ( 7.1 )].
Milnacipran label, warnings and precautionsIf it is necessary to initiate treatment with an MAOI such as linezolid or intravenous methylene blue in a patient taking SAVELLA, discontinue SAVELLA before initiating treatment with the MAOI [see Contraindications ( 4.1 ), Dosage and Administration ( 2.5 , 2.6 ), Drug Interactions ( 7.1 ) ].
Source: FDA drug label (Savella), NDA022256 (Abbvie), as published by Allergan, Inc., effective September 10, 2025 (SPL set 16a4a314-f97e-4e91-95e9-576a3773d284), 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
| Methylene blue | Milnacipran | |
|---|---|---|
| Labeled for | n/a | Nerve pain and fibromyalgia |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | n/a | $2.82 per tablet 100 mg tablet |
| 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