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Methylene blue is a repurposed prescription medicine that has many health benefits. Methylene blue
Marty Ross, MD discusses key facts, risks, and benefits of using methylene blue to treat Lyme and Bartonella.
Methylene blue works in three different ways to treat tick-borne infections.
While methylene blue may treat growing germs, the main reason to use it in Lyme or Bartonella infectious is to treat persisters and to break down Bartonella biofilms.
A Word About Persisters
Lyme and Bartonella are hard to treat for many reasons. One reason is persister Lyme and Bartonella germs ignore standard antibiotics. Based on numerous laboratory experiments since 2015, the Lyme germ and Bartonella have a growth state, as well as a hibernating, non-growing state. These hibernators are called persisters. They do not respond to regular prescription antibiotics, although they do seem to respond to many herbal antibiotics that we use.
People with chronic tick-borne infections often have low energy. One cause of low energy is called mitochondria dysfunction.
Every cell has 300 to 400 energy factories called mitochondria. Inside mitochondria sugar and fat are burned through a bunch of chemical reactions to create cell fuel called ATP. A final step in the production of ATP involves transferring electrons in an energy production process called oxidative phosphorylation.
Methylene blue patches interruptions in the oxidative phosphorylation electron transport chain. The methylene blue patch leads to quick improvements in mitochondrial production of ATP. With increased levels of ATP, cells run better. This can result in improved fatigue, but it also improves thinking, brain fog, and even immune function.
For additional ways to improve mitochondria function see How to Fix Mitochondria & Get Energy in Lyme Disease.
In addition to patching dysfunctional mitochondria, methylene blue helps thinking by blocking the destruction of a neurotransmitter called acetylcholine. For instance, raising acetylcholine levels is helpful in Alzheimer’s Disease to improve thinking.
Methylene blue is a blocker of an enzyme called cholinesterase that breaks down acetylcholine. When this enzyme is blocked, acetylcholine is not broken down as quickly leading to higher levels and improved thinking. This is how a number of drugs approved to treat Alzheimer’s Disease work. In my practice for some, raising acetylcholine with these Alzheimer's medicines can improve cognitive dysfunction. Methylene blue is not an approved drug for Alzheimer’s disease, but it raises acetylcholine levels in a similar way to these approved drugs and can improve thinking.
For a comprehensive strategy to treat brain fog see Brain Fog in Lyme Disease: You Can Fix It.
Methylene blue blocks an enzyme called monoamine oxidase (MAO). MAO inhibitors limit the breakdown of serotonin, norepinephrine, and dopamine. Increased levels of these neurotransmitters lift mood and can help with depression.
Methylene blue is approved by the FDA to treat methemoglobinemia. Methemoglobinemia is a condition where oxygen carried by hemoglobin inside red blood cells is not released into the tissues. Methylene blue causes the hemoglobin to release the oxygen.
There are two causes of methemoglobinemia. One is a genetic cause, and the other type is caused by certain medicines. In tick-borne illness treatments, treatments that use dapsone to treat Lyme or Bartonella can lead to methemoglobinemia. Treatments that use primaquine or tafenoquine to treat Babesia can also lead rarely to methemoglobinemia.
Symptoms of methemoglobinemia include blue lips and shortness of breath. If you are on dapsone, primaquine, or tafenoquine and these symptoms occur, adding oral methylene blue can help hemoglobin to release oxygen so that a person can remain on these drugs. There is also blood testing that can help diagnose the condition. If the condition is severe enough, the emergency room will provide methylene blue in an IV form.
Before starting methylene blue check a glucose 6 phosphate dehydrogenase (G6PD) blood test, If you have low levels of G6PD, methylene blue could break your red blood cells apart.
If you are on anti-depression medicines or other medicines that raise serotonin, you should also use Methylene blue with caution. Here is a complete list of medicines that the United States Food and Drug Administration (FDA) advises using with caution when using Methylene blue.
In my practice, I have used Methylene blue with a number of these restricted medicines, but I always try to use them at no more than one-half the upper dose limit. Talk to your healthcare provider before taking Methylene blue with these restricted medications.
The most common side effect of Methylene blue is that it will turn your urine and stool blue. It can take quite a bit of scrubbing to get off of the porcelain in the toilet too.
Rarely, some experience intestinal cramping on the medication.
In my practice about 5 percent of people have some bladder irritation, pressure or burning when on methylene blue. For these types of symptoms, the over-the-counter bladder pain medicine called pyridium can help. Pyridium is sold to help with bladder infection symptoms.
Methylene blue is provided by pharmaceutical companies for IV injection only. But compounding pharmacies can mix methylene blue powder and put it in capsules for oral administration. Currently in the United States, only two pharmacies compound this medication. One is PD Labs in Cedar Park, TX and the other is Infuserve in St. Petersburg, FL.
Note, methylene blue is very well absorbed in the intestines. It is very fat soluble and easily crosses over into the brain through the bloodstream across the blood-brain barrier. Because it is so fat soluble, it does not require liposomal preparations that these pharmacies offer. Rather, the non-liposomal preparations they offer work fine.
I only suggest using pharmacy grade methylene blue provided by compounding pharmacies. Methylene blue powder or drops found online may have contaminants such as heavy metals that concern me.
Combine with one of the following:
Combine with one of the following to address growing spirochete and intracellular (L-form) forms of Lyme:
Combine with one of the following to address growing cyst forms of Lyme:
For additional ideas on how to treat persisters see How to Treat Persister Lyme and Bartonella.
The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.
Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.
Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).
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