title: Methylene blue for distributive shock: a potential new use of an old antidote.
abstract: Methylene blue is used primarily in the treatment of patients with methemoglobinemia. Most recently, methylene blue has been used as a treatment for refractory distributive shock from a variety of causes such as sepsis and anaphylaxis. Many studies suggest that the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway plays a significant role in the pathophysiology of distributive shock. There are some experimental and clinical experiences with the use of methylene blue as a selective inhibitor of the NO-cGMP pathway. Methylene blue may play a role in the treatment of distributive shock when standard treatment fails.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, 455 First Avenue, Room 123, New York, NY, 10016, USA, Jangd01@nyumc.org.
authors.forename: David H
authors.initials: DH
authors.lastname: Jang
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
mesh_terms: D000707:Anaphylaxis / Q000503:physiopathology; D000818:Animals; D000931:Antidotes / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006152:Cyclic GMP / Q000037:antagonists & inhibitors / Q000378:metabolism; D004351:Drug Resistance; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000201:enzymology / Q000378:metabolism; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors / Q000737:chemistry / Q000378:metabolism; D008751:Methylene Blue / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008954:Models, Biological; D009131:Muscle, Smooth, Vascular / Q000187:drug effects / Q000201:enzymology / Q000378:metabolism; D009569:Nitric Oxide / Q000037:antagonists & inhibitors / Q000378:metabolism; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors / Q000737:chemistry / Q000378:metabolism; D015290:Second Messenger Systems / Q000187:drug effects*; D018805:Sepsis / Q000503:physiopathology; D012769:Shock / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000931:Antidotes; D004791:Enzyme Inhibitors; D007527:Isoenzymes; D009569:Nitric Oxide; D019001:Nitric Oxide Synthase; D006152:Cyclic GMP; D008751:Methylene Blue