| U.S. Brand Names |
| Urolene Blue® |
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| Generic Available |
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Yes |
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| Pharmacological Index |
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Antidote |
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| Use |
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Antidote for cyanide poisoning and drug-induced methemoglobinemia, indicator dye, chronic urolithiasis. |
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| Pregnancy Risk Factor |
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C (D if injected intra-amniotically) |
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| Contraindications |
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Renal insufficiency, hypersensitivity to methylene blue or any component, intraspinal injection |
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| Warnings/Precautions |
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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 |
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| Adverse Reactions |
|
>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 |
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| Overdosage/Toxicology |
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Symptoms of overdose include nausea, vomiting, precordial pain, hypertension, methemoglobinemia, cyanosis; overdosage has resulted in methemoglobinemia and cyanosis Treatment is symptomatic and supportive |
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| Mechanism of Action |
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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 |
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| Pharmacodynamics/Kinetics |
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Absorption: Oral: 53% to 97% Elimination: In bile, feces, and urine |
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| Usual Dosage |
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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) |
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| Administration |
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Administer I.V. undiluted by direct I.V. injection over several minutes |
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| Patient Information |
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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 |
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| Nursing Implications |
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Parenteral: Administer undiluted by direct I.V. injection over several minutes |
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| Dosage Forms |
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Injection: 10 mg/mL (1 mL, 10 mL) Tablet: 65 mg |
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| References |
|
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. |
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