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methylene blue

Generic ProvayBlue
Used for Anemia, Diagnosis

Methylene blue (ProvayBlue) is a thiazine dye that's FDA approved to treat methemoglobinemia, a serious condition where red blood cells can’t deliver oxygen properly to the body. It's also used off-label for conditions like malaria, shock, and as a diagnostic aid for imaging. The medication is typically given intravenously (IV) by a healthcare professional to adults and children who are in the hospital. The dosage is based on body weight. Side effects include headache, diarrhea, and low potassium or magnesium levels in the blood.

Reviewed by:
reviewerRobert Chad Hakim, PharmD, BCCCP
reviewerAllison Gourley, PharmD
Last reviewed on January 2, 2025
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What is Methylene blue (ProvayBlue)?

What is Methylene blue (ProvayBlue) used for?

How Methylene blue (ProvayBlue) works

Hemoglobin is a protein that carries oxygen throughout the body. Sometimes, when the body is exposed to certain medications or chemicals, it can create a different form called methemoglobin. Methemoglobin can’t carry oxygen, and too much of it leads to a serious condition called methemoglobinemia.

Methylene blue (ProvayBlue) is a thiazine dye. It works to treat methemoglobinemia by changing methemoglobin back to hemoglobin, so it can carry oxygen to the body.

Drug facts

Common BrandsProvayBlue
Drug ClassThiazine dye
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Side effects of Methylene blue (ProvayBlue)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

These side effects were reported in at least 2% of people:

  • Headache
  • Low blood potassium levels
  • Diarrhea
  • Low blood magnesium levels
  • Muscle twitches
  • Nausea

Less Common Side Effects

  • Fast heart rate
  • Blurry vision
  • Dry mouth
  • Muscle pain
  • Nasal congestion

Methylene blue (ProvayBlue) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Serious allergic reaction: hives, rash, blisters, skin reddening, swelling of the lips or tongue, difficulty breathing
  • Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness, muscle twitching or spasms, uncoordinated movement, distress, seizures, distress, hallucinations, coma
  • Hemolytic anemia (low red blood cell count): tiredness, dizziness, weakness, high heart rate, yellowing of the skin or eyes, dark-colored urine

Source: DailyMed

The following Methylene blue (ProvayBlue) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Incidence not known

Agitation

bluish-colored lips, fingernails, or palms

confusion

cough

dark urine

diarrhea

difficulty breathing

difficulty swallowing

dizziness or lightheadedness

fast heartbeat

fever

headache

hives or welts, itching, or skin rash

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

overactive reflexes

pale skin

poor coordination

rapid heart rate

redness of the skin

restlessness

shivering

sore throat

sweating

talking or acting with excitement you cannot control

tightness in the chest

trembling or shaking

twitching

unusual bleeding or bruising

unusual tiredness or weakness

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Abdominal or stomach pain

bigger, dilated, or enlarged pupils (black part of the eye)

blue staining of the urine, skin, and mucous membranes

bluish-colored lips, fingernails, or palms

blurred vision

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

confusion

dark urine

difficulty breathing

dizziness or lightheadedness

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

fear

fever

headache

increased sensitivity of the eyes to light

nausea

pale skin

rapid heart rate

rapid shallow breathing

shakiness in the legs, arms, hands, or feet

sore throat

tightness in the chest

unusual bleeding or bruising

unusual tiredness or weakness

vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Change in taste

changes in skin color

feeling hot or cold

increased sweating

loss of taste

muscle or joint pain

pain at the infusion site

pain in the arms or legs

Less common

Back pain

bruising

chills

general feeling of discomfort or illness

large, flat, blue or purplish patches in the skin

loss of appetite

muscle aches and pains

muscle spasm

runny nose

trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See more Methylene blue (ProvayBlue) side effects
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Pros and cons of Methylene blue (ProvayBlue)

Pros

  • Typically only given for 1 or 2 doses
  • Works quickly to relieve symptoms
  • Can be used in children and adults

Cons

  • Needs to be given as an infusion by a healthcare professional
  • Not safe during pregnancy or breastfeeding
  • Can turn your skin and body fluids blue
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Pharmacist tips for Methylene blue (ProvayBlue)

pharmacist
  • Your healthcare professional will give you methylene blue (ProvayBlue) as an IV injection over 5 to 30 minutes. Afterward, they’ll check your methemoglobin levels and look for symptoms of methemoglobinemia to decide if you need another dose.
  • People with G6PD deficiency are more likely to develop low red blood cell counts (hemolytic anemia) while taking methylene blue (ProvayBlue). They also might not respond well to the medication. Let your care team know if you have G6PD deficiency.
  • Methylene blue (ProvayBlue) can cause dizziness, confusion, and changes in vision. Avoid driving or doing tasks that require concentration until these side effects go away.
  • Methylene blue (ProvayBlue) has a dark blue color, which can turn your skin or body fluids blue. This discoloration can last for an unknown period, with some cases lasting over 3 years.
  • Methylene blue (ProvayBlue) can make your skin more sensitive to sunlight. Use sunscreen and wear long-sleeve clothing for a few days after treatment to protect your skin from sunburns.
  • Methylene blue (ProvayBlue) interacts with many medications, especially medications that raise serotonin and dapsone. Tell your care team about everything you’re taking, including prescription and over-the-counter medications.
  • Let your care team know if you're pregnant. Methylene blue (ProvayBlue) isn't recommended during pregnancy because there's a potential risk it can harm the unborn baby. Your care team will likely consider other treatment options.
  • There's not much information about the safety of methylene blue (ProvayBlue) during breastfeeding. But to avoid potential harm, don’t breastfeed for at least 8 days after your last dose.
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Risks and warnings for Methylene blue (ProvayBlue)

Methylene blue (ProvayBlue) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Serotonin syndrome

  • Risk factors: Taking other medications that raise serotonin levels in your brain

Black Box WarningSome people who received methylene blue (ProvayBlue) developed a rare but serious condition called serotonin syndrome. This condition happens where there's too much serotonin in the brain. Your risk is higher if you take methylene blue (ProvayBlue) with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and migraine medications. Tell your care team about all the medications you take before starting methylene blue (ProvayBlue). Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Let your care know right away if you have any of these symptoms.

Severe allergic reactions

Severe allergic reactions to methylene blue (ProvayBlue) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis. Let your care team know right away if you notice hives, swelling of the lips or tongue, or difficulty breathing after receiving this medication.

Hemolytic anemia (low red blood cells)

Methylene blue (ProvayBlue) can cause hemolytic anemia, which is when your red blood cells are broken down. This can happen 1 or more days after receiving the injection, and some people have had to get red blood cell transfusions to treat it. Your healthcare team will monitor your blood cell counts before and during treatment. Let them know if you have symptoms such as tiredness, dizziness, and weakness.

Don't drive

Methylene blue (ProvayBlue) can cause confusion, dizziness, and vision problems. Avoid driving or doing anything dangerous until these side effects go away. Talk to your prescriber if you have concerns.

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Methylene blue (ProvayBlue) dosage

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Interactions between Methylene blue (ProvayBlue) and other drugs

Methylene blue (ProvayBlue) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Methylene blue (ProvayBlue). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

See more Methylene blue (ProvayBlue) interactions
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Methylene blue (ProvayBlue) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Methylene blue (ProvayBlue) will not be safe for you to take.

References

Best studies we found

American Regent, Inc. (2024). ProvayBlue- methylene blue injection [package insert]. DailyMed.

Gumus, M., et al. (2013). How long will I be blue? Prolonged skin staining following sentinel lymph node biopsy using intradermal patent blue dye. Breast Care.

MedlinePlus. (2023). Glucose-6-phosphate dehydrogenase deficiency.

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