Methylene blue (Intravenous)

Methylene blue is a medication administered by injection that is used to treat the condition methemoglobinemia.

Overview

Methylene blue is a medication that is administered by injection. Methylene blue is used in the treatment of methemoglobinemia, which is a condition that results in the patient's blood being unable to deliver enough oxygen to the body. This happens when methemoglobin, a form of hemoglobin that does not carry oxygen to tissues, is present in sufficient numbers to replace hemoglobin and starve the tissues of oxygen. Patients can have a series of symptoms resulting from the lack of sufficient oxygen.

Methylene blue works by binding to the excess methemoglobin molecules so that hemoglobin can work to deliver oxygen.

Patients may be born with methemoglobinemia or may acquire it at any time throughout their lives.

Methylene blue is only available from your doctor, and the injection should only be administered by a medical professional or under the supervision of a medical professional. It will be injected slowly, over the course of at least 5 minutes, through an IV.

It is unknown whether methylene blue is safe for use by pregnant women, or if it may cause damage to the fetus. Before you take methylene blue, talk to your doctor about the risks that it may pose. He or she should help you to decide whether it is the right decision for you to take methylene blue.

There are possible side effects with methylene blue. Few patients will experience all of the side effects. Some of the side effects that you experience may be severe, and some will likely be mild. Talk to your doctor about any side effects that persist or worsen over time, or any side effects that concern you. Your doctor may be able to help you with ways to lessen the severity of some side effects. Do not stop taking your medication because of your side effects, unless your doctor or pharmacist instructs you to do so.

There are many medications that can cause interactions with methylene blue. Tell your doctor about all medications you are taking before you begin taking methylene blue. Do not begin taking any new medications while taking methylene blue without asking your doctor first. This includes prescription and over-the-counter medications, as well as vitamins and herbal supplements.

Other medical conditions may also make it unsafe for you to take methylene blue. Make sure your doctor knows your medical history and any other medical conditions that you have.

Conditions Treated

  • Methemoglobinemia

Type Of Medicine

  • MAO inhibitor

Side Effects

All medicines come with the risk of unintended side effects as well as the intended benefit of the drug. If you are concerned about any of the side effects that you are experiencing, talk to your doctor about them. Your doctor or pharmacist may be able to help you with ways to mitigate or prevent some of the side effects that you are experiencing.

If you experience any of the following side effects, talk to your doctor immediately:

  • Bad coordination
  • Blue color or tint to palms, fingernails, or lips
  • Bruising or bleeding
  • Chest tightness
  • Cough
  • Dark-colored urine
  • Diarrhea
  • Feeling agitated
  • Feeling confused
  • Feeling lightheaded or dizzy
  • Feeling of uncontrollable excitement
  • Feeling restless
  • Fever
  • Headache
  • Largely swollen area on genitals, feet, legs, hands, face, lips, eyes, or throat
  • Overactive reflexes
  • Pale skin
  • Rapid heartbeat or heart rate
  • Red skin
  • Shivering, trembling, or shaking
  • Sore throat
  • Trouble breathing
  • Trouble swallowing
  • Twitchiness
  • Unusual fatigue
  • Unusual sweating
  • Welts, hives, skin rash, or itching

Some side effects may be symptoms of overdose. If you experience any of the symptoms listed below, get emergency medical help immediately:

  • Blurring of your vision
  • Chest tightness
  • Dilated or enlarged pupils
  • Eyes are unusually sensitive to light
  • Fast heartrate
  • Feeling confused
  • Feeling dizzy or lightheaded
  • Feeling dizzy, lightheaded, or faint when rising
  • Fear
  • Nausea
  • Pain in your stomach or abdomen
  • Pale skin
  • Palms, fingernails, or lips are blue
  • Sensations of crawling, itching, burning, pins and needles, tingling, or prickling
  • Shallow, rapid breathing
  • Sore throat
  • Trouble breathing
  • Unusual bruising or bleeding
  • Unusual fatigue
  • Urine is dark colored
  • Urine, skin, or mucous membranes are stained blue

Some side effects do not require medical intervention. However, if any of the following side effects persist or worsen, or if they are severe or causing you problems, talk to your doctor. Your doctor may be able to help you lessen the severity of some side effects.

  • Appetite loss
  • Back pain
  • Bruising
  • Chills
  • Difficulty sleeping
  • General feeling of illness or discomfort
  • Increase in how much you sweat
  • Muscle spasms
  • Pain at the infusion site
  • Pain in the arms or legs
  • Pain or aching in the muscles or joints
  • Patches of blue or purple on the skin
  • Runny nose
  • Sensation of being hot or cold
  • Skin color changes
  • Taste changes or loss of taste

You may experience other side effects that have not been listed here. If you are concerned about any of the side effects that you are experiencing, talk to your doctor or pharmacist about them.

You may also report any side effects that you experience to the FDA at 800-FDA-1080.

Dosage

Your dosage will be determined by your doctor and will depend on information individual to you, such as your weight, the severity of your condition, and your body's response to treatment.

A typical dose may be something like this: 1 milligram per kilogram of body weight, administered by IV, over the course of 5 to 30 minutes.

Your doctor or medical professional will monitor your condition and determine if you are responding positively to the methylene blue dose. You may be given an additional dose if your doctor determines that it is necessary.

Interactions

Tell your doctor about all medications you are taking before you begin taking methylene blue. Do not begin taking any new medications while taking methylene blue without asking your doctor first. This includes prescription and over-the-counter medications, as well as vitamins and herbal supplements.

The following medications should not be used at the same time as methylene blue. Your doctor may take you off one of your medications.

  • Trazodone
  • Venlafaxine
  • Zolmitriptan
  • Tranylcypromine
  • Fluoxetine
  • Citalopram
  • Sumatriptan
  • Clomipramine
  • Doxylamine
  • Vortioxetine
  • Doxepin
  • Vilazodone
  • Nortriptyline
  • Rizatriptan
  • Amoxapine
  • Levodopa
  • Carbinoxamine
  • Mirtazapine
  • Pseudoephedrine
  • Selegiline
  • Safinamide
  • Tryptophan
  • Desvenlafaxine
  • Maprotiline
  • Carbidopa
  • Paroxetine
  • Protriptyline
  • Isocarboxazid
  • Sertraline
  • Opicapone
  • Amitriptyline
  • Amphetamine
  • Hydroxytryptophan
  • Duloxetine
  • Dextroamphetamine
  • Imipramine
  • Phenelzine
  • Milnacipran
  • Fluvoxamine
  • Lisdexamfetamine
  • Entacapone
  • Carbamazepine
  • Desipramine
  • Phentermine
  • Levomilnacipran
  • Trimipramine
  • Bupropion
  • Linezolid
  • Cyclobenzaprine
  • Escitalopram

The following medications are not recommended for use with methylene blue. However, taking them together may be necessary sometimes.

  • Oxymorphone
  • Palonosetron
  • Oxycodone
  • Oxymetazoline
  • Dextromethorphan
  • Moclobemide
  • Butorphanol
  • Sufentanil
  • Bromazepam
  • Hydrocodone
  • Buprenorphine
  • Dibenzepin
  • Lithium
  • Brompheniramine
  • Cocaine
  • Codeine
  • Furazolidone
  • Pentazocine
  • Procarbazine
  • Chlorpheniramine
  • Ondansetron
  • Dihydrocodeine
  • Rasagiline
  • Almotriptan
  • Eletriptan
  • Remifentanil
  • Tramadol
  • Amitriptylinoxide
  • Fentanyl
  • Buspirone
  • Iobenguane I 123
  • Atropine
  • Morphine
  • Sibutramine
  • Flibanserin
  • Tapentadol
  • Periciazine
  • Naratriptan
  • Methadone
  • Dolasetron
  • Difenoxin
  • Ziprasidone
  • Lofepramine
  • St John's Wort
  • Melitracen
  • Amineptine
  • Nefazodone
  • Morphine Sulfate Liposome
  • Frovatriptan
  • Lorcaserin
  • Iproniazid
  • Diphenoxylate
  • Tianeptine
  • Granisetron
  • Opipramol
  • Meperidine
  • Nialamide

Taking methylene blue with any of the following medications may increase the risk or severity of some side effects. Your doctor might decide that you should take both medications despite this risk. In this case, your doctor might change your dosage or the way you take one of the medications.

  • Insulin Glulisine
  • Insulin
  • Nateglinide
  • Insulin Aspart, Recombinant
  • Insulin Glargine, Recombinant
  • Tolbutamide
  • Acarbose
  • Glipizide
  • Insulin Degludec
  • Metformin
  • Tolazamide
  • Insulin Bovine
  • Chlorpropamide
  • Insulin Detemir
  • Repaglinide
  • Insulin Lispro, Recombinant
  • Glyburide
  • Glimepiride

Some foods may interact with certain medications. Your doctor or pharmacist will tell you if there are certain foods that you should avoid, or if you need to maintain a special diet of any kind while taking methylene blue.

Tobacco may cause interactions with some medications. Make sure you talk to your doctor or pharmacist about your tobacco use. Your doctor or pharmacist will tell you if you need to alter your use of tobacco in order to ensure the optimal functioning of methylene blue.

Warnings

Make sure that your doctor is aware of your medical history. Your doctor needs to know about any medical conditions that you have or have had in the past. Other medical conditions may affect the way you need to take methylene blue or may make methylene blue dangerous for you to take. Make sure your doctor knows if you have any of the following medical conditions:

  • Kidney disease¬†- the effects of methylene blue may be strengthened as it will be removed more slowly from the body
  • Liver disease¬†- the effects of methylene blue may be strengthened as it will be removed more slowly from the body
  • Glucose-6-phosphate dehydrogenase deficiency (G6PD)¬†- taking methylene blue with this condition may cause hemolytic anemia or exacerbate methemoglobinemia

Some of these conditions may make it unsafe for you to take methylene blue. Others may mean that you need to use caution or be aware of certain symptoms. Your doctor will tell you about how your condition may change the way you need to take methylene blue.

Tell your doctor or medical professional if you have any allergies. It is possible that methylene blue may have inactive ingredients that you are allergic to.

Methylene blue can cause anaphylaxis or other serious allergic reactions. If you have any of the symptoms of a severe allergic reaction, get medical attention immediately. Signs of anaphylaxis include fainting, rapid breathing, gasping for breath, irregular heartbeat, and changes in skin color.

Your doctor should be checking your progress regularly while you are taking methylene blue. Your doctor needs to monitor your condition in order to determine whether methylene blue is working properly.

You should not take methylene blue while you are pregnant. Use birth control to make sure that you do not get pregnant while taking methylene blue. If you think you are pregnant while taking methylene blue, tell your doctor right away.

It is not known whether methylene blue passes into breastmilk. Breastfeeding women should not take methylene blue. If you are breastfeeding, talk to your doctor about the risks it may pose to your baby. You may need to stop breastfeeding while you are on methylene blue.

Dizziness, vision problems, and confusion are potential side effects of methylene blue. Avoid driving, operating machinery, or performing operations that require you to be clear until you know how methylene blue will affect you.

If you need to have any medical tests, make sure the doctor knows that you are using methylene blue. Methylene blue may affect the results of some medical tests.

Methylene blue can make your skin more sensitive to the sun. Make sure you use sunscreen and avoid tanning beds and sunlamps while you are on methylene blue.

Storage

Methylene blue will be stored and diluted by your doctor or medical professional. It should not be used if there are any particulates visible in

 

the solution.

Do not use expired medications. Do not flush unused medications down the toilet, pour them in the sink, or throw them in the garbage. Ask your pharmacist how to dispose of unused medications safely and appropriately.

Summary

Methylene blue is an MAO inhibitor that is used to treat a condition known as methemoglobinemia. Methemoglobinemia is a condition that prevents the body tissues from getting as much oxygen as they need.

Methylene blue is not safe for use by pregnant women. If you are a woman of child-bearing age, use effective birth control methods to ensure that you do not get pregnant while taking methylene blue. Methylene blue may be dangerous to your fetus. If you suspect that you have become pregnant while taking methylene blue, tell your doctor immediately.

There is a risk of side effects from taking methylene blue, which range from mild to severe. Talk to your doctor about any side effects that persist or get worse over time.

Methylene blue will be administered to you by a doctor, nurse, or other medical professional. It is administered slowly through an IV over the course of 5 to 30 minutes.