Diferencia entre revisiones de «Methylene blue»
(Created page with "==Administration== *Type: Antidote *Dosage Forms: *Routes of Administration: IV *Common Trade Names: ==Adult Dosing== *Acquired methemoglobinemia: 1 mg/kg IV over 5-30min, m...") |
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==Administration== | ==Administration== | ||
*Type: Antidote | *Type: [[Antidote]], [[Vasopressors]] | ||
*Routes of Administration: IV | *Routes of Administration: IV | ||
==Adult Dosing== | ==Adult Dosing== | ||
*Acquired methemoglobinemia: 1 mg/kg IV over 5-30min, may repeat in 1h with up to 1 mg/kg IV if methemoglobin level still >30% or symptoms persist | *Acquired methemoglobinemia: 1 mg/kg IV over 5-30min, may repeat in 1h with up to 1 mg/kg IV if methemoglobin level still >30% or symptoms persist | ||
*Drug-induced methemoglobinemia: 1-2 mg/kg IV slowly over several minutes | *Drug-induced methemoglobinemia: 1-2 mg/kg IV slowly over several minutes | ||
*See [[vasopressors]] | |||
**For hypotension refractory to catecholamine pressors | |||
**Consider after catecholamine, [[vasopressin]], and mineralocorticoid refractive shock | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Same as weight-based adult dosing | *Same as weight-based adult dosing | ||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Fetal risk has been demonstrated | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: X, Fetal risk has been demonstrated | ||
*[[Lactation risk categories|Lactation risk]]: Infant risk cannot be ruled out | *[[Lactation risk categories|Lactation risk]]: Infant risk cannot be ruled out | ||
*Renal dosing: no adjustment | *Renal dosing: no adjustment | ||
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*Allergy to class/drug | *Allergy to class/drug | ||
*G6PD deficiency | *G6PD deficiency | ||
*[[ARDS]] | |||
*[[Pulmonary hypertension]] | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious<ref>Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.</ref>=== | ||
*Hemolytic anemia | *Hemolytic anemia | ||
*Syncope | *Syncope | ||
*Serotonin syndrome | *Serotonin syndrome | ||
*Paradoxical [[methemoglobinemia]] at doses > 4 mg/kg/hr or per bolus | |||
*Pulmonary vasoconstriction at 3-4 mg/kg/hr or per bolus | |||
===Common=== | ===Common=== | ||
*Skin discoloration, urine discoloration, hyperhidrosis | *Skin discoloration, urine discoloration, hyperhidrosis | ||
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==Mechanism of Action== | ==Mechanism of Action== | ||
*Promotes non-enzymatic redox conversion of methemoglobin to hemoglobin | *Promotes non-enzymatic redox conversion of methemoglobin to hemoglobin | ||
*Improves vascular tone via inhibition of nitric oxide synthase | |||
==Comments== | ==Comments== | ||
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<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Toxicology]] | |||
Revisión actual - 23:19 28 dic 2023
Administration
- Type: Antidote, Vasopressors
- Routes of Administration: IV
Adult Dosing
- Acquired methemoglobinemia: 1 mg/kg IV over 5-30min, may repeat in 1h with up to 1 mg/kg IV if methemoglobin level still >30% or symptoms persist
- Drug-induced methemoglobinemia: 1-2 mg/kg IV slowly over several minutes
- See vasopressors
- For hypotension refractory to catecholamine pressors
- Consider after catecholamine, vasopressin, and mineralocorticoid refractive shock
Pediatric Dosing
- Same as weight-based adult dosing
Special Populations
- Pregnancy Rating: X, Fetal risk has been demonstrated
- Lactation risk: Infant risk cannot be ruled out
- Renal dosing: no adjustment
- Hepatic dosing: no adjustment
Contraindications
- Allergy to class/drug
- G6PD deficiency
- ARDS
- Pulmonary hypertension
Adverse Reactions
Serious[1]
- Hemolytic anemia
- Syncope
- Serotonin syndrome
- Paradoxical methemoglobinemia at doses > 4 mg/kg/hr or per bolus
- Pulmonary vasoconstriction at 3-4 mg/kg/hr or per bolus
Common
- Skin discoloration, urine discoloration, hyperhidrosis
- Nausea, abnormal taste
- Limb pain
- Dizziness, headache
Pharmacology
- Half-life: 24h
- Metabolism: Hepatic
- Excretion: Mostly renal
Mechanism of Action
- Promotes non-enzymatic redox conversion of methemoglobin to hemoglobin
- Improves vascular tone via inhibition of nitric oxide synthase
Comments
See Also
References
- ↑ Pasin L et al. Methylene blue as a vasopressor: a meta-analysis of randomised trials. Crit Care Resusc. 2013 Mar;15(1):42-8.