Methylene Blue for the Treatment of Septic Shock

• Published in: Pharmacotherapy 2010-07, Vol.30 (7), p.702-715
• Main Authors: Paciullo, Christopher A., Horner, Deanna McMahon, Hatton, Kevin W., Flynn, Jeremy D.
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Clinical Trials as Topic; Dyes; Emergency and intensive care: infection, septic shock; Guanylate Cyclase - pharmacology; Hemodynamics - drug effects; Human bacterial diseases; Humans; Infectious diseases; Intensive care medicine; Lung - drug effects; Medical sciences; methylene blue; Methylene Blue - pharmacology; Nitric Oxide - pharmacology; Pharmacology. Drug treatments; Randomized Controlled Trials as Topic; Retrospective Studies; Sepsis; septic shock; Shock, Septic - drug therapy; Shock, Septic - physiopathology; Vasodilation - drug effects; vasodilatory shock; vasopressor
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.30.7.702

Septic shock is a major cause of morbidity and mortality in the intensive care unit, and effective therapies are limited. Methylene blue is a selective inhibitor of guanylate cyclase, a second messenger involved in nitric oxide‐mediated vasodilation. The use of methylene blue in the treatment of septic shock has been repeatedly evaluated over the past 20 years, but data remain scarce. To evaluate the safety and efficacy of methylene blue for the treatment of septic shock, we conducted a literature search of the EMBASE (1974‐June 2009), MEDLINE (1966‐June 2009), and International Pharmaceutical s (1970‐June 2009) databases. All available studies published in English were reviewed. Observational studies with methylene blue have demonstrated beneficial effects on hemodynamic parameters and oxygen delivery, but use of methylene blue may be limited by adverse pulmonary effects. Methylene blue administration is associated with increases in mean arterial pressure while reducing catecholamine requirements in patients experiencing septic shock; however, its effects on morbidity and mortality remain unknown. Well‐designed, prospective evaluations are needed to define the role of methylene blue as treatment of septic shock.