title: Safety of methylene blue dye for lymphatic mapping in patients taking selective serotonin reuptake inhibitors.
abstract: Methylene blue dye has an important role in lymphatic mapping for sentinel lymph node surgery. A recent safety announcement from the US Food and Drug Administration warned physicians about possible serious central nervous system reactions in patients on serotonergic medications who received intravenous methylene blue for the identification of parathyroid glands. This report summarizes evidence from the Food and Drug Administration's announcement and methylene blue pharmacokinetics. The authors conclude that the use of methylene blue dye at low doses for lymphatic mapping likely carries very little risk for serotonin neurotoxicity, although breast surgeons should be aware of this potential complication in the event of mental status or neuromuscular changes in patients after lymphatic mapping.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Miraj G
authors.initials: MG
authors.lastname: Shah-Khan
authors.forename: Jenna
authors.initials: J
authors.lastname: Lovely
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D002490:Central Nervous System / Q000187:drug effects*; D004396:Coloring Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008751:Methylene Blue / Q000009:adverse effects* / Q000493:pharmacokinetics; D017410:Practice Guidelines as Topic; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue; D017367:Selective Serotonin Reuptake Inhibitors