Most authorities recommend that it be given no more quickly than over a five-minute period. It is recommended that methylene blue be slowly administered intravenously. The generally recommended dose for methylene blue is 1 to 2 mg/kg or 0.2 mL/kg of the 1% solution.

Methylene blue is generally formulated as a 1% solution providing 10 mg of drug per milliliter of solution. Other commonly used names for this drug are aniline violet, methylthionine chloride, and tetramethylthionine chloride. This antidote may be found by the trade name Urolene Blue or by the generic name methylene blue.

The antidote currently recommended for severe methemoglobinemia is methylene blue. In other words, those with symptoms from methemoglobinemia who also have significant underlying diseases that may interfere with proper oxygenation of tissues (heart failure, coronary insufficiency, COPD, significant anemia, etc.) should receive antidotal therapy when methemoglobin levels fall to between 10% and 30%. The symptoms of patients suffering from methemoglobinemia can vary depending in large part on the total hemoglobin level that the patient normally has.

It is essential to remember that methemoglobin levels are reported by most laboratories as a percentage of total hemoglobin. In the face of acute methemoglobinemia, the level at which antidotal therapy is considered essential is generally approximately 20% to 30% methemoglobin. There are indeed patients who suffer from congenital forms of methemoglobinemia, and who can tolerate high systemic methemoglobin concentrations without ever developing significant symptomatology. In fact, many patients will do quite well with meticulous supportive care only. It is important to remember, however, that not all patients require an antidote for methemoglobinemia. Once the diagnosis of significant methemoglobinemia has been made, treatment should begin without delay.

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Methylene blue antidote