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Health Guide

Methylene blue (Intravenous route)

Pronunciation:

METH-i-leen BLOO

Brand Names:

  • Provayblue

Dosage Forms:

  • Solution

Warnings:

Intravenous route(Solution)

Methylene blue may cause serious or fatal serotonergic syndrome when used in combination with serotonergic drugs. Avoid concomitant use of methylene blue with selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors .

Classifications:

Therapeutic—

Diagnostic Agent, Kidney Function

Uses of This Medicine:

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.

This medicine is to be given only by or under the supervision of a doctor.

Before Using This Medicine:

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 this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine 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.

Children—

Safety and efficacy have been established in pediatric patients.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of methylene blue injection in the elderly. However, elderly patients are more likely to have kidney problems, which may require caution and an adjustment in the dose for patients receiving this medicine.

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.

Other 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 this medicine, 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 this medicine 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
  • Amphetamine
  • Benzphetamine
  • Bupropion
  • Carbamazepine
  • Carbidopa
  • Carbinoxamine
  • Citalopram
  • Clomipramine
  • Codeine
  • Cyclobenzaprine
  • Desipramine
  • Desvenlafaxine
  • Deutetrabenazine
  • Dextroamphetamine
  • Doxepin
  • Doxylamine
  • Duloxetine
  • Entacapone
  • Escitalopram
  • Fluoxetine
  • Fluvoxamine
  • Hydroxytryptophan
  • Imipramine
  • Isocarboxazid
  • Levodopa
  • Levomilnacipran
  • Linezolid
  • Lisdexamfetamine
  • Maprotiline
  • Meperidine
  • Methamphetamine
  • Milnacipran
  • Mirtazapine
  • Nortriptyline
  • Opicapone
  • Paroxetine
  • Phenelzine
  • Phentermine
  • Protriptyline
  • Pseudoephedrine
  • Rizatriptan
  • Safinamide
  • Selegiline
  • Sertraline
  • Sumatriptan
  • Tapentadol
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Trimipramine
  • Tryptophan
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Zolmitriptan

Using this medicine 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.

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

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

Other interactions—

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 this medicine. 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 or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given through a needle placed in one of your veins. The medicine must be injected slowly, so your IV tube will need to stay in place for 5 to 30 minutes.

Precautions While Using This Medicine:

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

Using this medicine 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 this medicine, tell your doctor right away.

This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis requires immediate medical attention. The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, or fainting. Other signs may include changes in color of the skin of the face, very fast but irregular heartbeat or pulse, hive-like swellings on the skin, and puffiness or swellings of the eyelids or around the eyes. If these side effects occur, get emergency help at once.

Make sure your doctor knows about all the other medicines you are using. This medicine may cause a serious condition called serotonin syndrome when taken with other medicines to treat depression (eg, 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 (eg, eletriptan, sumatriptan, zolmitriptan, Imitrex®, Relpax®, or Zomig®), ergot medicine (eg, ergotamine, Cafergot®, Ergomar®, or Wigraine®), or certain antibiotics (eg, 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 this medicine. The results of some tests may be affected by this medicine.

This medicine may cause dizziness, confusion, or trouble in seeing clearly. Make sure you know how you react to this medicine before you drive, use machines, or do other jobs that require you to be alert or able to see well.

This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

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:

Incidence not known
Agitation
bluish-colored lips, fingernails, or palms
confusion
cough
dark urine
diarrhea
difficulty breathing
difficulty swallowing
dizziness or lightheadedness
fast heartbeat
fever
headache
hives or welts, itching, or skin rash
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
overactive reflexes
pale skin
poor coordination
rapid heart rate
redness of the skin
restlessness
shivering
sore throat
sweating
talking or acting with excitement you cannot control
tightness in the chest
trembling or shaking
twitching
unusual bleeding or bruising
unusual tiredness or weakness

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

Symptoms of overdose
Abdominal or stomach pain
bigger, dilated, or enlarged pupils (black part of the eye)
blue staining of the urine, skin, and mucous membranes
bluish-colored lips, fingernails, or palms
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
confusion
dark urine
difficulty breathing
dizziness or lightheadedness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fear
fever
headache
increased sensitivity of the eyes to light
nausea
pale skin
rapid heart rate
rapid shallow breathing
shakiness in the legs, arms, hands, or feet
sore throat
tightness in the chest
unusual bleeding or bruising
unusual tiredness or weakness
vomiting

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
Change in taste
changes in skin color
feeling hot or cold
increased sweating
loss of taste
muscle or joint pain
pain at the infusion site
pain in the arms or legs
Less common
Back pain
bruising
chills
general feeling of discomfort or illness
large, flat, blue or purplish patches in the skin
loss of appetite
muscle aches and pains
muscle spasm
runny nose
trouble sleeping

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.


Last Updated: 9/4/2017
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