View source for Methylene blue

{{DrugProjectFormSinglePage
|authorTag={{TA}}
|genericName=Methylene blue
|aOrAn=a
|drugClass=heterocyclic aromatic chemical compound
|indicationType=treatment
|indication=Drug induced methemoglobinemia
|adverseReactions=[[Hypertension]], [[hypotension]], sweating symptom, [[abdominal pain]], [[diarrhea]], [[nausea]], [[vomiting]], [[dizziness]], [[headache]] and [[confusion]]
|blackBoxWarningTitle=<b><span style="color:#FF0000;">TITLE</span></b>
|blackBoxWarningBody=<i><span style="color:#FF0000;">Condition Name:</span></i> (Content)
|fdaLIADAdult====Indications===
*Drug induced methemoglobinemia

===Dosage===
*0.1 to 0.2 mL per kilogram of body weight (0.045 to 0.09 mL per pound of body weight). Inject Methylene Blue intravenously very slowly over a period of several minutes.
|offLabelAdultGuideSupport=*There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Methylene blue in adult patients.
|offLabelAdultNoGuideSupport=*There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of Methylene blue in adult patients.
|fdaLIADPed=Safety and effectiveness in pediatric patients have not been established.
|offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Methylene blue in pediatric patients.
|offLabelPedNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of Methylene blue in pediatric patients.
|contraindications=*Methylene blue can cause fetal harm when administered to a pregnant woman. An association exists between the use of methylene blue in amniocentesis and atresia of the ileum and jejunum, ileal occlusions and other adverse effects in the neonate. Methylene blue is contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
*Intraspinal injection is contraindicated.
*Methylene blue is contraindicated in patients with a known hypersensitivity to the drug.
|warnings=*Methylene Blue should not be given by subcutaneous or intrathecal injection.
*Methylene blue is a potent [[monoamine oxidase inhibitor]]: Methylene blue has been demonstrated to be a potent monoamine oxidase inhibitor (MAOI) and may cause potentially fatal serotonin toxicity ([[serotonin syndrome]]) when combined with serotonin reputake inhibitors (SRIs). Serotonin toxicity is characterized by development of neuromuscular hyperactivity ([[tremor]], [[clonus]], [[myoclonus]] and [[hyperreflexia]], and, in the advanced stage, pyramidal rigidity); autonomic hyperactivity (diaphoresis, fever, [[tachycardia]], [[tachypnoea]], and [[mydraisis]]); and altered mental status ([[agitation]], excitement, and in the advanced stage, [[confusion]]). If methylene blue is judged to be indicated, SRIs must be ceased, prior to treatment/procedure/surgery.

===Precautions===
*[[Glucose-6-Phosphate Dehydrogenase Deficiency]] (G6PD): Methylene blue should be avoided in patients with G6PD deficiency due to the risk of paradoxical [[methemoglobinemia]] and [[hemolysis]].
|clinicalTrials=*Large intravenous doses of Methylene Blue produce [[nausea]], abdominal and [[precordial pain]], [[dizziness]], [[headache]], profuse sweating, [[confusion|mental confusion]] and the formation of methemoglobin.
|postmarketing=*There is limited information regarding <i>postmarketing experience</i>
|drugInteractions=*Methylene blue may interact with any drug that acts as a serotonin reuptake inhibitor (SRI) including, amongst others, selective serotonin reuptake inhbitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), norepinephrine-dopamine reuptake inhibitors (NDRIs), triptans and ergot alkaloids; such combinations may have the consequence of potentially fatal serotonin toxicity ([[serotonin syndrome]]). Methylene blue should not be co-administered with any drug that acts as an SRI.
|FDAPregCat=X
|useInPregnancyFDA=*Epidemiologic evidence exists that Methylene blue is a teratogen. An association exists between the use of methylene blue in amniocentesis and atresia of the ileum and jejunum, ileal occlusions and other adverse effects in the neonate. Methylene blue Injection should not be administered to pregnant women during amniocentesis due to the risk of teratogenicity and other newborn adverse effects
|useInRenalImpair=*Renal Failure: Methylene blue should be used with caution in patients with severe renal impairment .
|administration=*Intravenous.
|monitoring=*There is limited information regarding <i>drug monitoring</i>.
|IVCompat=*There is limited information regarding <i>IV compatibility</i>.
|drugBox={{chembox2
| Watchedfields = changed
| verifiedrevid = 476992187
| Name = Methylene blue
| ImageFile = Methylene blue.svg
| ImageSize = 220px
| ImageName = Methylene blue
| ImageFile1 = Methylene-blue-ox-3D-vdW.png
| ImageSize1 = 
| ImageName1 = Space-filling model of methylene blue in its oxidised form
| IUPACName = 3,7-bis(Dimethylamino)-<br />phenothiazin-5-ium chloride
| OtherNames = C.I. 52015
|Section1={{Chembox Identifiers
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 5874
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 8NAP7826UB
| InChI1 = 1/C16H18N3S.ClH/c1-18(2)11-5-7-13-15(9-11)20-16-10-12(19(3)4)6-8-14(16)17-13;/h5-10H,1-4H3;1H/q+1;/p-1
| InChIKey1 = CXKWCBBOMKCUKX-REWHXWOFAR
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C16H18N3S.ClH/c1-18(2)11-5-7-13-15(9-11)20-16-10-12(19(3)4)6-8-14(16)17-13;/h5-10H,1-4H3;1H/q+1;/p-1
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = CXKWCBBOMKCUKX-UHFFFAOYSA-M
| CASNo = 61-73-4
| CASNo_Ref = {{cascite|correct|CAS}}
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 6872
| SMILES = CN(C)c1ccc2c(c1)sc-3cc(=[N+](C)C)ccc3n2.[Cl-]
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 405110
| PubChem =6099
| ATCCode_prefix = V03
| ATCCode_suffix = AB17
| ATC_Supplemental = {{ATC|V04|CG05}}
}}
|Section2={{Chembox Properties
| Formula = C<sub>16</sub>H<sub>18</sub>N<sub>3</sub>SCl
| MolarMass = 319.85 g/mol
| Density =
| MeltingPtC = 100 to 110
| Melting_notes = (with decomposition)
| BoilingPt = Decomposes
}}
}}
|mechAction=*Methylene blue is Phenothiazin-5-ium, 3,7-bis (dimethylamino)-, chloride, trihydrate. It will produce two opposite actions on hemoglobin. Low concentrations will convert methemoglobin to hemoglobin. High concentrations convert the ferrous iron of reduced hemoglobin to ferric iron which results in the formation of methemoglobin.
|structure=*Methylene Blue Injection, USP is a sterile solution of methylene blue in water for injection suitable for parenteral administration.
[[File:Methylenblue1.jpeg|thumb|none|400px|This image is provided by the National Library of Medicine.]]

*Each mL of solution contains 10 mg of methylene blue and water for injection q.s. pH adjusted with hydrochloric acid and/or sodium hydroxide when necessary.
|PD=*There is limited information regarding <i>pharmacodynamics</i>.
|PK=*There is limited information regarding <i>pharmacokinetics</i>.
|nonClinToxic=*There is limited information regarding <i> nonclinical toxicology</i>.
|clinicalStudies=*There is limited information regarding <i>clinical studies</i>.
|howSupplied=Methylene Blue Injection, USP, 1% is supplied as follows:

NDC 17478-504-01
1 mL in 2 cc (partially filled) vials in packages of 10.

NDC 17478-504-10
10 mL vials in packages of 10.

The vials are packaged with a Flip Tear-Off Seal. The seal can either be flipped normally to reveal the rubber stopper or be totally removed so the rubber stopper can be taken out of the vial. The plastic button is attached to the metal seal, which when pulled, tears the seal at the score line allowing the metal portion to be removed.
|storage=STORAGE: Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature].
|packLabel=[[File:Methyleneblue4.jpeg|thumb|none|400px|This image is provided by the National Library of Medicine.]]
[[File:Methyleneblue5.jpeg|thumb|none|400px|This image is provided by the National Library of Medicine.]]
[[File:Methyleneblue6.png|thumb|none|400px|This image is provided by the National Library of Medicine.]]
|fdaPatientInfo=*There is limited information regarding <i>Patient Counseling Information</i>.
|alcohol=Alcohol-Methylene blue interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
|brandNames=* METHYLENE BLUE®<ref>{{Cite web | title = METHYLENE BLUE- methylene blue injection  | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fde64824-2be5-4d85-8d57-5098ca6890bb}}</ref>
|lookAlike=*There is limited information regarding <i>Look-Alike Drug Names</i>.
}}

[[Category:Antidotes]]
[[Category:Histology]]
[[Category:Drug]]
[[Category:Vital stains]]
[[Category:Monoamine oxidase inhibitors]]
[[Category:Phenothiazines]]
[[Category:Chlorides]]