Methylene Blue Injection : Indications, Dosage & Brands

Methylene Blue injection is an FDA approved treatment for Methemoglobinemia. This article covers several aspects of details related to methylene blue injection and its availibility.
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What is Methylene Blue Injection

Methylene blue injection is a sterile version of Methylene blue solution that falls under the category of antidotes. It is used to treat methemoglobinemia, cyanide poisoning and urinary tract infections. this situation arises When blood loses its ability to supply oxygen to where it is required in the body.

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What is Methylene Blue injection used for

Methylene Blue injection is used to treat methemoglobinemia. Methemoglobin levels in the blood are extraordinarily high in this situation. Exposure to certain drugs or chemicals, such as nitrates, can cause methemoglobinemia. Hemoglobin is a blood protein that carries and distributes oxygen to tissues and organs. Methemoglobin, on the other hand, is not oxygen-transporting hemoglobin. Methemoglobin is only present in trace amounts in the blood. When methemoglobin levels grow, the blood’s ability to circulate oxygen decreases. Skin that is pale or blue in color might indicate a lack of oxygen in the body.

Indications

  • Methylene blue injection has been approved by the FDA to treat methemoglobinemia.
  • When epinephrine is ineffective, Methylene blue is used to treat vasoplegic syndrome, a kind of distributive shock that occurs after cardiac surgeries (especially coronary artery bypass grafting) to increase vascular resistance.
  • Methylene blue is also used as a dye during a lumpectomy/mastectomy to see if any lymph nodes if any, show cancer signs.
  • It can assist reduce post-injection pain when given 45 seconds before the injection of propofol.

Dosage

Methylene blue is administered intravenously to both children and adults with methemoglobinemia at a dosage of 1 mg/kg of a 1% solution over 5 to 30 minutes. The most often used dosages of methylene blue for lymph node mapping are 2 mL and 5 mL of a 1% solution injected into intraparenchymal tissues. When administered 45 seconds before propofol delivery to reduce post-injection discomfort, the dosage is 50 mg given as a 2 mL bolus.

Methylene blue is administered intravenously at a dosage of 50 mg at an interval of 4 hours until undetectable in the treatment of ifosfamide-induced encephalopathy. Methylene blue is also administered for 20 minutes at a dose of 2 mg/kg for a patient suffering from vasoplegic syndrome, and it can be given both before and after the patient is operated on to minimize mortality. Methylene blue is given intravenously 1 hour prior to the parathyroidectomy at a dosage of 5mg/mL to recognize the parathyroid glands. Plasmodium falciparum therapy needs three days of treatment at a supplemental dose of 36 to 72 mg/kg of methylene blue injection.

Methylene Blue injection is given 0.1 to 0.2 millilitres per kilogramme of the patient’s body weight (0.045 to 0.09 mL per pound of the patient’s body weight). Methylene Blue injection should be injected intravenously very slowly in a span of a few minutes.

How do you use methylene blue injection?

Methylene blue is given through an IV injection into a vein. It may take up to half an hour to complete the IV injection.

While getting a MB injection, the patient’s respiration, blood pressure, oxygen levels, renal function, and other vital indicators are continuously monitored. Their blood sample is also tested for the doctor to assess whether or not the medication is functioning.

Methylene blue may only need to be given to the patient once. A second dosage can be administered 1 hour after the first dose if necessary.

Methylene blue injection works by reducing the oxidised form of haemoglobin, Fe3+, to Fe2+.  As a result, haemoglobin’s oxygen-binding capacity will rise, as will oxygen delivery to organs.

How is it supplied

Methylene blue injections are usually available at pharmacy stores and can be purchased if you have a prescription. The injections are available in the following packaging:-

  • Ten packets of 1 ml in 2 cc (partially filled) vials.
  • Packages of ten 10 ml vials
  • Packages of ten 1 1 ml ampules.
  • Packages of ten 10 ml ampules

The vials come with a Flip Tear-Off Seal. The seal may be turned usually to show the rubber stopper or completely removed to allow the rubber stopper to be removed from the vial. The metal seal is linked to the plastic button, that can be pulled to break the seal at the scoreline, allowing the metal component to be separated.

Storage

Methylene Blue should be stored at temperatures ranging from 20°C to 25°C (68°F to 77°F).

Methylene Blue Injection Brands

Methylene Blue injection is available under various brand names. Some of them are mentioned below.

Brands Company Countries
Azuphen MB Burel Pharmaceuticals USA
Azul de Metileno Euromed Chile
Azul de Metileno Volta Laboratorio Chile
Azul de Metileno Laboratorios Servinsumos Colombia
Bluejet 10ML INJ Vulcan Laboretories PVT. LTD India
Basic Blue 9 Zhejiang Dragon Chemical Technology Co. China
Methylthioninium chloride Proveblue Lamepro Netherlands
Metiblo Laboratoires Sterop Belgium
Methylene blue Injection Alveda pharmaceuticals INC Canada
Methylene Blue Injection USP Solution Teligent USA
Methylthioninium chloride Proveblue Ethypharm UK
Methylthioninium chloride Provepharm France
Methylthioninium chloride Bioindustria Italy
Proveblue Clinect New Zealand
Proveblue American Regent USA
ProvayBlue Injection Henry Schein USA
Methylthioninium Chloride Flexipharma UK
Sam MB Samarth India
Blucan American Remedies Healthcare Pvt. Ltd. India
MB Bio Health Biotech India
Blue Beam Flagship Biotech International India
Problu-10 Methylene Blue Injection Protech Telelinks India
Corblu Orley Laboratories PVT LTD India

Side Effects

The bluish-green coloration of urine is one of the most prevalent side effects of methylene blue. Another side effect is limb discomfort after IV treatment. When taken with other serotonergic medications, methylene blue may lead to serotonin syndrome. Serotonin syndrome causes an increase in sympathetic and neuromuscular activity, resulting in symptoms such as diaphoresis, clonus, and tremors. Methylene blue can induce CNS symptoms such as dizziness, confusion, and headaches in adults. There has been a history of Methylene blue injection resulting in respiratory depression, pulmonary edema, hyperbilirubinemia, phototoxicity, and hemolytic anaemia in newborns.

Precautions

The patient should not be treated with Methylene blue injection if they have a deficiency of glucose-6-phosphate dehydrogenase. Many drugs can interact with Methylene blue so, it’s essential for the patient to tell their doctor if they are on any medications.

Because of its potential to decrease renal blood flow, methylene blue should be used with caution in individuals with renal insufficiency. Furthermore, as mentioned in the adverse effects section, patients taking any medication with serotonergic action, such as SSRIs, should avoid using methylene blue owing to the possibility of serotonin syndrome.

Intra-articular Methylene Blue Injection

The intra-articular injection of methylene blue is a safe and straightforward way to detect joint capsule rupture and allow for early management.

A methylene blue intra-articular injection that shows dye extravasation from the lesion site is strongly indicative of open joint damage. Open joint damage may still exist in the lack of dye extravasation; thus, orthopaedic consultation is suggested for all individuals with a suspicious open joint injury.

FAQs

Q. What happens if you drink Methylene Blue?

If you accidentally drink Methylene Blue, then it can cause a few side effects like vomiting, trouble breathing, fastened heart rate, tremors, blue-colored lips, numbness and anxiety

Q. How can methylene blue injection be used for cattle?

Although Methylene Blue is not particularly approved for veterinary use, it can be given in low doses at times of emergency to treat methemoglobinemia in cattle.

Q. How can we use Methylene Blue injection in COVID treatment?

Methylene Blue has anti-viral properties, so it is effective for patients who have mild symptoms of Covid. The inclusion of Methylene Blue to the treatment regimens of Covid 19 reduced SpO2 and respiratory distress in COVID-19 patients, resulting in a shorter hospital stay and lower mortality. However, the use of methylene blue for Covid is not yet approved and no individual should self administer it without guidance from a medical professional.

Q. How do you dilute methylene blue injection?

Methylene blue is hypotonic and can be diluted in a solution of glucose 50 mg/mL (5%) for injection. An appropriate dilution for oral dosage would be 10-20 mL of the 0.5 per cent solution diluted to 100-200 mL with water.

Q. How long does methylene blue stay in your system?

It stays in the body for about 5 to 24 hours, varying among individuals.

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