Methylene Blue

Some of the potential benefits include but are not limited to:

• Anti-aging effects by enhancing mitochondrial function
• Neuroprotective effects, with potential in the management of Alzheimer’s and Parkinson’s diseases
• Antioxidant and anti-inflammatory effects
• Enhanced cellular energy regulation via increased ATP synthesis and mitochondrial function

Methylene Blue holds an indication for the treatment of methemoglobinemia, where it acts as a reducing agent to restore the oxygen-carrying capacity of hemoglobin. Beyond this use, it has also been studied for its potential in managing Lyme disease and co-infections such as Bartonella, due to its antimicrobial properties, ability to penetrate biofilms, and potential to target persistent forms of Borrelia burgdorferi.

Potential Side Effects

Methylene Blue is generally well-tolerated, but potential side effects may include:

• Blue discoloration of urine
• Blue discoloration of mouth cavity with the troche
• Headaches
• Nausea
• Increased blood pressure or dizziness, especially if taken in higher doses

Drug interactions

• There is a potential risk of serotonin syndrome when used concurrently with serotonergic agents such as SSRIs and trazodone. Providers should monitor for signs of serotonin excess, including agitation, confusion, tremor, or autonomic instability, in patients on multiple serotonergic medications.

Precautions

• Methylene Blue is contraindicated in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD) due to the risk of hemolytic anemia

Methylene Blue works primarily by enhancing mitochondrial function. It supports the electron transport chain, which improves mitochondrial function and increases ATP (adenosine triphosphate) synthesis. Methylene Blue also acts as a potent antioxidant, neutralizing harmful free radicals that can cause cellular damage. It helps modulate the body’s inflammatory response, which can be beneficial in reducing inflammation-related damage

Q. Can I take take Methylene Blue with SSRI medications?

A. Methylene Blue poses a theoretical risk of serotonin syndrome, a rare but dangerous drug interaction where high amounts of serotonin produced cause symptoms like diarrhea, agitation, increased heartbeat and blood pressure. Though serotonin syndrome has been observed with intravenous methylene blue, typical oral doses are much lower. ¹

Jiang Z, Duong TQ. Methylene blue treatment in experimental ischemic stroke: a mini review. Brain Circ. 2016;2(1):48-53. doi: 10.4103/2394-8108.178548. PMID: 27042692; PMCID: PMC4817094.

Tucker D, Lu Y, Zhang Q. From Mitochondrial Function to Neuroprotection-an Emerging Role for Methylene Blue. Mol Neurobiol. 2018 Jun;55(6):5137-5153. doi: 10.1007/s12035-017-0712-2. Epub 2017 Aug 24. PMID: 28840449; PMCID: PMC5826781.

Pushparajah Mak, Renita S. MD^∗; Liebelt, Erica L. MD^∗,†. Methylene Blue: An Antidote for Methemoglobinemia and Beyond. Pediatric Emergency Care 37(9):p 474-477, September 2021. | DOI: 10.1097/PEC.0000000000002526

Feng J, Weitner M, Shi W, Zhang S, Sullivan D, Zhang Y. Identification of Additional Anti-Persister Activity against Borrelia burgdorferi from an FDA Drug Library. Antibiotics (Basel). 2015 Sep 16;4(3):397-410. doi: 10.3390/antibiotics4030397. PMID: 27025631; PMCID: PMC4790293.