From Theory to Therapy: Methylene Blue's Emerging Role in the Management of Septic Shock

Purpose: Methylene blue was FDA-approved for the treatment of acquired methemoglobinemia. However, it has also shown benefits in other disease states such as β-blocker and calcium channel blocker overdoses, vasoplegia, and ifosfamide-induced encephalopathy. More recently, methylene blue has emerged as a potential catecholamine sparing agent for the treatment of septic shock through inhibition of the nitric oxide pathway, which is responsible for vasodilation. Studies suggest that methylene blue decreases vasopressor requirements for critically ill patients with minimal safety risks. This clinical review aims to review the pharmacology, efficacy, and safety surrounding methylene blue use in patients with septic shock. Summary: Six studies conducted between 2000 and 2024 were identified. In randomized studies, methylene blue appears to be safe and effective in improving hemodynamics in patients with septic shock. This review discusses pharmacology, pharmacotherapy, and primary literature surrounding methylene blue in septic shock. Conclusion: Based on review of the available literature, authors conclude that methylene blue is an appropriate catecholamine-sparing treatment option for patients with septic shock. However, drug-drug interactions should be carefully reviewed before administration due to the risk of serotonin syndrome when combined with other serotonergic agents.