The pharmacotherapeutic options in patients with catecholamine-resistant vasodilatory shock

Administration of methylene blue in septic shock: pros and cons

“…MB is a non-expensive and widely available molecule, which has been most commonly used to treat severe methemoglobinemia in the context of poisoning. When administered intravenously, MB has an onset of action of 30-60 min with a terminal plasma half-life of 5-6 h [23,24]. It is metabolized by the liver and excreted primarily by the kidneys, so that patients with dysfunction of these organs have a higher risk of toxicity and drug interactions through cytochrome P450 inhibition [23].…”

“…MB is generally well tolerated and toxicity is dose related; blue-green discoloration of urine, skin, and secretions is commonly described, which can interfere with the accuracy of pulse oximeter readings. More severe adverse effects, such as mesenteric vasoconstriction and paradoxical methemoglobinemia, have been reported with higher doses up to 4 mg/kg [24]. Inhibition of monoamine oxidase A by MB can induce a serotonin syndrome.…”

“…[31]. Two recent meta-analyses included the study by Ibarra-Estrada et al [24]. In a meta-analysis of 11 randomized controlled trials in perioperative or critically ill patients, Pruna et al [32] suggested that MB administration may be associated with improved hemodynamics, reduced ICU and hospital lengths of stay, and lower mortality (relative risk 0.60 [95% CI, 0.43-0.84]; p = 0.003), while in a meta-analysis of 6 randomized controlled trials assessing MB use in patients with distributive shock, Huang et al reported reduced duration of mechanical ventilation and hospital length of stay in MB-treated patients, but no effect on mortality [33].…”