CLINICAL QUICK REFERENCE / THE SUPPLEMENT GUIDE
METHYLENE BLUE: IS IT RIGHT FOR YOU? A BRIEF NOTE ON THE POTENTIAL FOR TOXICITY
Did you know that methylene blue was the first synthetic drug ever used in medicine?
Methylene blue was first used as a dye in the textile industry. Methylene blue was originally synthesized in 1876 by Heinrich Caro as a textile dye for cotton. It was later discovered to have medical applications, including as a stain for microscopic samples.
Methylene blue was among the first drugs used for the treatment of patients with psychosis at the end of the 19th century. It played a major role in the development of phenothiazine antipsychotic drugs in the mid-20th century.
Prescription Use & A Few Precautions To Consider When Using
This synthetic product has been traditionally prescribed for use in the management of some medical conditions (particularly methemoglobinemia). Methemoglobinemia is a condition in which the patient’s hemoglobin has diminished capacity to carry oxygen.
It also has been used as a diagnostic aid, as the dye is absorbed in larger amounts in rapidly-dividing cells.
Methylene blue is generally safe when prescribed and used properly. However, like many other therapeutics, it still has the potential to cause harm. Certain groups of people may be at higher risk than others.
A frequent side effect of methylene blue is the bluish-green tint of urine. Another frequent side effect is pain in the limbs after IV administration.
Were you aware that methylene blue can lead to serotonin syndrome when used with other serotonergic medications?
These include drugs such as:
SSRIs,
SNRIs,
MAOIs,
and TCAs.
This is because methylene blue possesses MAOI activity.
Serotonin syndrome raises sympathetic and neuromuscular function; thus, symptoms like diaphoresis, clonus, and tremor could occur.
Clinicians caution against using methylene blue with:
•bupropion
•clomipramine
•doxepin
•duloxetine
•fluoxetine
•MAOIs like Marplan, Nardil, and Parnate
•milnacipran
•mirtazapine
•rasagiline
•selegiline
•St. John's wort
•trazodone
•tryptophan
***This list does not describe all possible interactions. Make sure your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use.***
Adults prescribed methylene blue have reported symptoms related to the central nervous system, including dizziness, confusion, and headaches.
The administration of methylene blue in newborns has resulted in hyperbilirubinemia, respiratory depression, pulmonary edema, phototoxicity, and hemolytic anemia.
Methylene blue is not recommended for patients who have shown hypersensitivity or anaphylaxis after previous use, as well as for individuals with glucose-6-phosphate dehydrogenase deficiency because of their risk of developing hemolytic anemia.
Methylene blue is likewise not recommended for pregnant women.
The FDA has designated methylene blue with a pregnancy class X rating because of intestinal atresia and fetal demise after an intra-amniotic injection, particularly during the second trimester.
If you are thinking about using this product, make sure to talk to your primary care doctor and give them a complete list of all medications, herbs, over-the-counter drugs, or dietary supplements before you begin.