Methylene Blue

Aka: Methylene Blue, Methylthioninium Chloride

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II. Indications

  1. Methemoglobinemia
    1. Converts methemoglobin to Hemoglobin when administered IV
  2. Surgical Dye
    1. Trace lymphatic chain during oncology surgery (identify sentinel Lymph Node)

III. Precautions

  1. Methylene Blue supplements
    1. Off-label consumer use as a mitochrondrial, cognition or athletic booster
    2. No evidence of any benefit for these "booster" uses and risk of adverse effects (avoid)

IV. Mechanism

  1. Primary
    1. Synthetic dye
    2. Binds negatively charged ions (e.g. Nucleic Acids)
  2. Alzheimer Disease (investigational)
    1. Inhibits misfolding/aggregation of amyloid beta and tau Proteins (Alzheimer Disease)
    2. Oral formulation (138 mg/day) may improve cognition for 6 months in alzheimer Dementia
      1. However, no effect when combined with standard treatments (e.g. Aricept, Namenda)
      2. Hashmi (2023) Cureus 15(10):e46732 +PMID: 38022191 [PubMed]

V. Adverse Effects

  1. Common systemic effects
    1. Gastrointestinal upset
    2. Dysuria
    3. Blue-Green Urine Discoloration
  2. Serious
    1. Hemolytic Anemia
    2. Serotonin Syndrome (when combined with other serotonergic agents)

VI. Drug Interactions

  1. Serotonergic agents (e.g. SSRI, St Johns Wort)
  2. Avoid within 2 weeks of surgery

VII. Safety

  1. Unknown safety in pregnancy (avoid)
  2. Unknown safety in Lactation (avoid)

VIII. References

  1. (2025, Jan) Presc Insights 33(1):420116

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