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methylene blue (Intravenous route)

METH-i-leen BLOO

Available Dosage Forms:

  • Solution

Therapeutic Class: Diagnostic Agent, Kidney Function

Uses For methylene blue

Methylene blue injection is used to treat a condition called methemoglobinemia. This condition occurs when the blood cannot deliver oxygen where it is needed in the body. Methylene blue injection is also used as a dye to stain certain parts of the body before or during surgery.

methylene blue is to be given only by or under the direct supervision of a doctor.

Before Using methylene blue

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For methylene blue, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to methylene blue or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

No information is available on the relationship of age to the effects of methylene blue injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

No information is available on the relationship of age to the effects of methylene blue injection in geriatric patients.

Pregnancy

Pregnancy Category Explanation
All Trimesters X Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving methylene blue, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using methylene blue with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

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

Using methylene blue with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Albuterol
  • Almotriptan
  • Arformoterol
  • Bambuterol
  • Buspirone
  • Clenbuterol
  • Colterol
  • Fenoterol
  • Fentanyl
  • Formoterol
  • Frovatriptan
  • Hexoprenaline
  • Hydrocodone
  • Indacaterol
  • Iobenguane I 123
  • Isoetharine
  • Levalbuterol
  • Lorcaserin
  • Meperidine
  • Metaproterenol
  • Morphine
  • Morphine Sulfate Liposome
  • Naratriptan
  • Nefazodone
  • Oxycodone
  • Oxymorphone
  • Pirbuterol
  • Procaterol
  • Reproterol
  • Ritodrine
  • Salmeterol
  • Terbutaline
  • Tramadol
  • Tretoquinol
  • Tulobuterol
  • Vilanterol

Using methylene blue with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acarbose
  • Acetohexamide
  • Benfluorex
  • Chlorpropamide
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Guar Gum
  • Insulin
  • Insulin Aspart, Recombinant
  • Insulin Degludec
  • Insulin Detemir
  • Insulin Glargine, Recombinant
  • Insulin Glulisine
  • Insulin Human Regular
  • Insulin Lispro, Recombinant
  • Metformin
  • Miglitol
  • Repaglinide
  • Tolazamide
  • Tolbutamide
  • Troglitazone

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of methylene blue. Make sure you tell your doctor if you have any other medical problems, especially:

  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency (a hereditary metabolic disorder affecting red blood cells)—May cause hemolytic anemia or make methemoglobinemia worse.
  • Kidney disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of methylene blue

A nurse or other trained health professional will give you methylene blue in a hospital. methylene blue is given through a needle placed in one of your veins.

methylene blue must be given very slowly, so the needle will remain in place for several minutes.

Precautions While Using methylene blue

Your doctor will check your progress closely while you are receiving methylene blue. This will allow your doctor to see if the medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using methylene blue while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using methylene blue, tell your doctor right away.

Make sure your doctor knows about all the other medicines you are using. methylene blue may cause a serious condition called serotonin syndrome when taken with other medicines to treat depression (such as amitriptyline, bupropion, citalopram, desipramine, duloxetine, escitalopram, fluoxetine, fluvoxamine, imipramine, nortriptyline, paroxetine, sertraline, venlafaxine, Aventyl®, Celexa®, Cymbalta®, Effexor®, Elavil®, Lexapro™, Luvox®, Norpramin®, Pamelor®, Paxil®, Prozac®, Tofranil®, Wellbutrin®, or Zoloft®), medicine to treat migraine headaches (such as eletriptan, sumatriptan, zolmitriptan, Imitrex®, Relpax®, or Zomig®), ergot medicine (such as ergotamine, Cafergot®, Ergomar®, or Wigraine®), or certain antibiotics (linezolid, Zyvox®). Check with your doctor first before taking any other medicines. The symptoms of serotonin syndrome include mental changes (confusion, hyperactivity, memory problems), muscle twitching, excessive sweating, shivering or shaking, diarrhea, trouble with coordination, or fever.

Before you have any medical tests, tell the doctor in charge that you are using methylene blue. The results of some tests may be affected by methylene blue.

methylene blue Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
  • Anxiety
  • back pain
  • bluish fingernails, lips, or skin
  • chest pain
  • chills
  • confusion
  • difficulty with breathing
  • dizziness
  • headache
  • leg pain
  • nausea and vomiting
  • severe sweating
  • stomach pain
  • trembling
  • unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Greenish blue to blue discoloration of the urine and stools
Less common
  • Diarrhea
  • nausea and vomiting
  • painful urination or increased need to urinate

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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