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methylene blue (oral and injection)

Pronunciation: METH i leen BLOO

Brand: Urolene Blue

What is the most important information I should know about methylene blue?

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Do not use methylene blue if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

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Many drugs can interact with methylene blue. Tell your doctor about all other medications you use. You may need to stop using certain medicines before using methylene blue (in some cases for up to 5 weeks before you start methylene blue). During your treatment with methylene blue, do not start or stop using any other medications unless your doctor tells you to.

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You should not use this medication if you are allergic to methylene blue, or if you have severe kidney problems.

Before using methylene blue, tell your doctor if you have kidney disease, or glucose-6-phosphate dehydrogenase (G6PD) deficiency.

Also tell your doctor about all other medications you use, especially antacids, diuretics (water pills), sodium bicarbonate, or acetazolamide (Diamox).

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If you take an antidepressant or psychiatric medication, call your doctor right away if you have signs of a serious drug interaction, including: confusion, memory problems, feeling hyperactive (mentally or physically), loss of coordination, muscle twitching, shivering, sweating, diarrhea, and/or fever.

Methylene blue will most likely cause your urine or stools to appear blue or green in color. This is a normal side effect of the medication and will not cause any harm.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using methylene blue.

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Call your doctor at once if you have a serious side effect such as severe vomiting or stomach pain, pain in your chest or behind your breast bone, pale or blue skin, high fever, fast or pounding heartbeats, trouble breathing, confusion, or feeling like you might pass out.

What is methylene blue?

Methemoglobin is a form of hemoglobin (HEEM o glo bin). Hemoglobin is a substance in blood that carries oxygen and distributes it to your tissues and organs. However, methemoglobin is not a type of hemoglobin that is useful in carrying oxygen.

Methemoglobin normally exists in small amounts in the blood. However, when methemoglobin levels increase, the blood is less efficient in circulating oxygen. The resulting lack of oxygen throughout the body can cause symptoms such as pale or blue-colored skin.

Methemoglobinemia is a condition in which methemoglobin is present in high levels in the blood. Methemoglobinemia usually occurs when a person is exposed to certain drugs or chemicals such as nitrites. It may also be caused by a genetic disorder.

Methylene blue injection is used to treat methemoglobinemia. It works by converting methemoglobin to a more efficient type of hemoglobin to better carry oxygen throughout the body.

Methylene blue oral is used to treat methemoglobinemia and urinary tract infections. It works as a mild antiseptic to kill bacteria in the urinary tract. You will most likely also be given an antibiotic medication to treat your infection.

Methylene blue is also used as a dye or staining agent to make certain body fluids and tissues easier to view during surgery or on an x-ray or other diagnostic exam.

Methylene blue may also be used for purposes not listed in this medication guide.

What should I discuss with my health care provider before taking methylene blue?

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Do not use methylene blue if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

During your treatment with methylene blue, do not start or stop using any other medications unless your doctor tells you to.

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Many drugs can interact with methylene blue. Tell your doctor about all other medications you use. You may need to stop using certain medicines before using methylene blue (in some cases for up to 5 weeks before you start methylene blue). However, do not stop taking any of your medications without your doctor's advice. This includes:

  • meperidine (Demerol);
  • diet pills, stimulants, cold or allergy medicines, ADHD medication;
  • migraine or cluster headache medication such as almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, Treximet), or zolmitriptan (Zomig);
  • medication to treat Parkinson's disease or restless leg syndrome, such as carbidopa or levodopa (Lodosyn, Parcopa, Sinemet), pramipexole (Mirapex), or ropinirole (Requip);
  • an "SSRI" antidepressant such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft);
  • an "SNRI" antidepressant such as venlafaxine (Effexor), desvenlafaxine (Pristiq), or duloxetine (Cymbalta);
  • a "tricyclic" antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil); or
  • other medications used to treat depression, anxiety, and other psychiatric conditions, such as bupropion (Wellbutrin, Zyban, Aplenzin), buspirone (BuSpar), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone, trazodone (Desyrel, Oleptro), or vilazodone (Viibryd).
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You should not use this medication if you are allergic to methylene blue, or if you have severe kidney problems.

To make sure you can safely use methylene blue, tell your doctor if you have any of these other conditions:

  • kidney disease; or
  • glucose-6-phosphate dehydrogenase (G6PD) deficiency.
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FDA pregnancy category C. It is not known whether methylene blue will harm an unborn baby, but the medication may sometimes be used during pregnancy. Your doctor will determine whether or not this medication is safe or if it will harm the unborn baby. Before you are treated with methylene blue, tell your doctor if you are pregnant.

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It is not known whether methylene blue passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take methylene blue?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

The usual dose of oral methylene blue is 1 or 2 tablets after meals, 3 times per day.

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Take the methylene blue tablet after a meal, with a full glass (8 ounces) of water.

Methylene blue injection is injected into a vein through an IV. You will receive this injection in a clinic or hospital setting.

To be sure this medication is helping your condition, your blood may need to be tested often. This will help your doctor determine how long to treat you with methylene blue. Visit your doctor regularly.

Methylene blue will most likely cause your urine or stools to appear blue or green in color. This is a normal side effect of the medication and will not cause any harm.

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This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using methylene blue.

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Store methylene blue tablets at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

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Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe forms of some of the side effects listed in this medication guide.

What should I avoid while taking methylene blue?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

What are the possible side effects of methylene blue?

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Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

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Call your doctor at once if you have a serious side effect such as:

  • severe nausea, vomiting, or stomach pain;
  • pain in your chest or behind your breast bone;
  • pale or blue skin;
  • high fever, fast or pounding heartbeats, trouble breathing; or
  • confusion, feeling like you might pass out.

Less serious side effects may include:

  • mild bladder irritation;
  • mild nausea, vomiting, diarrhea, upset stomach;
  • dizziness;
  • headache; or
  • increased sweating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect methylene blue?

Tell your doctor about all other medications you use, especially:

  • acetazolamide (Diamox);
  • antacids;
  • sodium bicarbonate; or
  • a diuretic (water pill) such as hydrochlorothiazide, HCTZ, Accuretic, Aldactazide, Aldoril, Atacand HCT, Avalide, Capozide, Diovan HCT, Dyazide, HydroDiuril, Hyzaar, Inderide, Lopressor HCT, Lotensin HCT, Maxzide, Moduretic, Vaseretic, Zestoretic, Ziac, and others.

This list is not complete and other drugs may interact with methylene blue. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

Your doctor or pharmacist can provide more information about methylene blue.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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