Yes

Antidote

Antidote for cyanide poisoning and drug-induced methemoglobinemia, indicator dye, chronic urolithiasis.

C (D if injected intra-amniotically)

Renal insufficiency, hypersensitivity to methylene blue or any component, intraspinal injection

Do not inject S.C. or intrathecally; use with caution in young patients and in patients with G-6-PD deficiency; continued use can cause profound anemia

>10%:

Gastrointestinal: Fecal discoloration (blue-green)

Genitourinary: Discoloration of urine (blue-green)

1% to 10%: Hematologic: Anemia

<1%: Hypertension, precordial pain, dizziness, mental confusion, headache, fever, stains skin, nausea, vomiting, abdominal pain, bladder irritation, diaphoresis

Symptoms of overdose include nausea, vomiting, precordial pain, hypertension, methemoglobinemia, cyanosis; overdosage has resulted in methemoglobinemia and cyanosis

Treatment is symptomatic and supportive

Weak germicide in low concentrations, hastens the conversion of methemoglobin to hemoglobin; has opposite effect at high concentrations by converting ferrous ion of reduced hemoglobin to ferric ion to form methemoglobin; in cyanide toxicity, it combines with cyanide to form cyanmethemoglobin preventing the interference of cyanide with the cytochrome system

Absorption: Oral: 53% to 97%

Elimination: In bile, feces, and urine

Children: NADPH-methemoglobin reductase deficiency: Oral: 1-1.5 mg/kg/day (maximum: 300 mg/day) given with 5-8 mg/kg/day of ascorbic acid

Children and Adults: Methemoglobinemia: I.V.: 1-2 mg/kg or 25-50 mg/m² over several minutes; may be repeated in 1 hour if necessary

Adults: Genitourinary antiseptic: Oral: 65-130 mg 3 times/day with a full glass of water (maximum: 390 mg/day)

Administer I.V. undiluted by direct I.V. injection over several minutes

May discolor urine and feces blue-green; take oral formulation after meals with a glass of water; skin stains may be removed using a hypochlorite solution

Parenteral: Administer undiluted by direct I.V. injection over several minutes

Injection: 10 mg/mL (1 mL, 10 mL)

Tablet: 65 mg

Burnakis TG, "Inadvertent Substitution of Methylene Blue for Indigo Carmine to Detect Premature Rupture of Membranes," Hosp Pharm, 1995, 30(4):336-8.

Dawson AH and Whyte IM, "Management of Dapsone Poisoning Complicated by Methaemoglobinaemia," Med Toxicol Adverse Drug Exp, 1989, 4(5):387-92.

DiSanto AR and Wagner JG, "Pharmacokinetics of Highly Ionized Drugs II: Methylene Blue - Absorption, Metabolism, and Excretion in Man and Dog After Oral Administration," J Pharm Sci, 1972, 61(7):1086-90.

Harvey JW and Keitt AS, "Studies of the Efficacy and Potential Hazards of Methylene Blue Therapy in Aniline-Induced Methaemoglobinaemia," Br J Haematol, 1983, 54(1):29-41.

Preiser JC, Lejeune P, Roman A, et al, "Methylene Blue Administration in Septic Shock: A Clinical Trial," Crit Care Med, 1995, 23(2):259-64.

Zulian GB, Tullen E, and Maton B, "Methylene Blue for Ifosfamide-Associated Encephalopathy," N Engl J Med, 1995, 332(18):1239-40.