Methylene Blue, Midodrine, and Pseudoephedrine

Berkel, Megan A. Van; Fuller, Laura A.; Alexandrov, Anne W.; Jones, G. Morgan

doi:10.1097/cnq.0000000000000086

Cited by 4 publications

(2 citation statements)

References 47 publications

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“…43,44 Other drugs that may be utilized in the therapy of postural hypotension include pseudoephedrine, the noradrenaline receptor inhibitor atomoxetine, the α2-adrenergic receptor yohimbine, the cholinesterase inhibitor pyridostigmine and the somatostatin analogue octreotide. [45][46][47][48][49] In refractory subjects, combination therapies, e.g. fludrocortisone plus midodrine should be considered.…”

Section: Detecting Cardiac Denervation In the Patient With Diabetesmentioning

confidence: 99%

Detecting and treating the protean manifestations of diabetic autonomic neuropathy

Bell¹

2023

Diabetes Obesity Metabolism

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The manifestations of diabetic autonomic neuropathy (DAN) are protean and clinically involve multiple systems, including the cardiovascular system, the gastrointestinal system, the genitourinary system as well as the sweat glands (sudomotor dysfunction) and the gallbladder. In addition, cardiac autonomic neuropathy (CAN) is associated with a correctible inability to appreciate and correct hypoglycaemia. While not a clinical problem, pupillary involvement should be the clue and the catalyst to investigate for other manifestations of DAN. This review outlines a practical approach to detecting and investigating the manifestations of DAN. Of particular importance is early detection of cardiovascular involvement where prompt therapy through glycaemic control can decrease the severity of CAN and decelerate the frequency and severity of retinopathy and nephropathy in addition to decreasing cardiovascular events and mortality. CAN also plays a role in accelerating other diabetic complications such as acute ischaemic stroke, heart failure, medial artery calcinosis, foot ulcers, peripheral artery disease and Charcot joints. Many therapies of DAN are available, which should not only decrease morbidity and mortality from DAN, but also improve the patient's quality of life. However, the therapies available are largely symptomatic.

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Section: Detecting Cardiac Denervation In the Patient With Diabetesmentioning

confidence: 99%

Detecting and treating the protean manifestations of diabetic autonomic neuropathy

Bell¹

2023

Diabetes Obesity Metabolism

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“…The redox dye methylthioninium chloride, commonly called methylene blue (MethyB), has long been known as an antidote in the treatment of cyanide poisoning [1] and in methemoglobinemia, causing reduction of methemoglobin to hemoglobin [2]. The dye has also been employed to prevent and/or reverse encephalopathy caused by the chemotherapeutic drug ifosfamide, to treat vasoplegic shock in neonates [3], and refractory hypotension in adults [4], and as an adjunctive agent reducing residual depression and anxiety in subjects with bipolar depression [5]. Studies in experimental animals indicated the ability of the dye to prevent neurodegeneration under different circumstances.…”

Section: Introductionmentioning

confidence: 99%

Neuro- and Hepatoprotective Effects of Methylene Blue in Rats Treated with Lipopolysaccharide Endotoxin

Abdel-Salam

Sleem

Youness

et al. 2018

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The effects of methylene blue (MethyB) on oxidative stress markers in the serum and on the brain and liver tissue damage following lipopolysaccharide (LPS) injection in rats were studied. Rats received intraperitoneal (i.p.) injection of LPS (300 µg/kg) alone or along with MethyB (5 and 10 mg/kg) and euthanized 4 h later. Malondialdehyde (MDA), nitric oxide, paraoxonase-1 (PON-1) activity, cholinesterase activity, and glucose were measured in the serum. The brain and liver histopathology, glial fibrillary acidic protein (GFAP), and caspase-3 immunostaining in the brain were performed. Results indicated that LPS treatment caused significantly raised MDA and nitric oxide concentrations by 52.8% and 47.5%, respectively. Cholinesterase activity was not significantly changed, but PON1 activity fell by 48.1%. Serum glucose increased by 48.7%. When administered to LPS-injected rats, MethyB resulted in significant decreases in serum MDA and nitric oxide concentrations, respectively. PON-1 activity increased by 37.8-89.3%, cholinesterase activity decreased by 33.4-41.2%, and serum glucose decreased by 39.6% upon MethyB treatment. Neurodegeneration, increased capsase-3 staining, decreased GFAP immunostaining in the brain and vacuolar degeneration and inflammatory cell infiltrates in the liver of LPS-treated rats were almost prevented by MethyB. These data suggest that MethyB exerts an antioxidant action and ameliorates brain and liver tissue damage during endotoxemia.

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Hemodynamic support is typically initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure with subsequent adequate organ reperfusion. Unfortunately, high catecholamine dosing requirements may be necessary to achieve targeted hemodynamic goals that may increase the risk of vasopressor‐induced adverse events. The purpose of this article is to review the clinical efficacy and safety data and potential role in therapy for catecholamine‐sparing agents in vasodilatory shock. Adjunctive therapeutic options to reduce vasoactive support requirements without compromising arterial pressure include arginine vasopressin and analogs, corticosteroids, midodrine, methylene blue, and angiotensin II. Although concomitant vasopressin and corticosteroids have a more defined role in evidence‐based guidelines for managing shock, clinicians may consider other potential catecholamine‐sparing agents.

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Methylene Blue, Midodrine, and Pseudoephedrine

Cited by 4 publications

References 47 publications

Detecting and treating the protean manifestations of diabetic autonomic neuropathy

Detecting and treating the protean manifestations of diabetic autonomic neuropathy

Neuro- and Hepatoprotective Effects of Methylene Blue in Rats Treated with Lipopolysaccharide Endotoxin

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

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