Critical
Bupropion × Methylthioninium chloride (methylene blue)
Other antidepressants (NDRI)×Antidotes (V03AB17). The drug has one FDA-approved indication – methaemoglobinaemia. Biohacker use is off-label.
Mechanism
IV methylene blue is a potent reversible MAO-A inhibitor. Bupropion inhibits dopamine and norepinephrine reuptake. Combined action raises monoamines sharply, risking hypertensive crisis and seizures.
Symptoms
Hypertension, tachycardia, tremor, agitation, headache. Seizures may occur (bupropion lowers seizure threshold). Serotonin syndrome is less common unless other serotonergics are involved.
Management
Avoid the combination. IV methylene blue is reserved for emergencies with bupropion withdrawn 14 days in advance. If unavoidable for methaemoglobinaemia on bupropion, give for life-threatening indications with blood pressure monitoring and anticonvulsants ready.