Mighty Methylene Blue for Tick-borne Infections and More

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Methylene Blue for Lyme and Bartonella Persisters

Methylene Blue Actions–What All The Buzz is About

Methylene blue is a repurposed prescription medicine that has many health benefits. Methylene blue

  • kills Bartonella and Borrelia,
  • improves fatigue and mitochondria dysfunction,
  • fixes cognitive dysfunction and brain fog,
  • lifts depression, and
  • treats methemoglobinemia (this is what it is approved to treat).

All About Methylene Blue for Lyme and Bartonella

Marty Ross, MD discusses key facts, risks, and benefits of using methylene blue to treat Lyme and Bartonella.

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Bartonella and Borrelia (Lyme)—Persisters, Biofims and Growing Forms

Methylene blue works in three different ways to treat tick-borne infections.

  • Persisters. Methylene blue treats persister (hibernating) Borrelia and Bartonella.
  • Growing Forms. There is also lab evidence showing it treats growing Bartonella. It likely kills growing Lyme too.
  • Biofilms. It also is shown in lab experiments to break down Bartonella biofilms.

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.

Mitochondria Dysfunction Repair to Improve Thinking, Brain Fog, Energy, and Immune Function

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.

More About Brain Fog and Cognitive Dysfunction

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.

Role in Depression

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.

Side Effects

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.

Get from a Compounding Pharmacy

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.

How to Build a Methylene Blue Treatment

Bartonella Infection

  • Methylene blue 50 mg 1 pill 2 times a day (this is made by a compounding pharmacy). In one to two months, If there is an inadequate response, consider increasing to 2 pills 2 times a day.

Combine with one of the following:

  • Azithromycin 500 mg 1 pill 1 time a day;
  • Clarithromycin 500 mg 1 pill 2 times a day;
  • Minocycline 100 mg 1 pill 2 times a day;
  • Doxycycline 100 mg 1 pill 2 times a day;
  • Rifampin 300 mg 2 pills 1 time a day; or
  • Fluconazole 200 mg 1 time a day.

Lyme Infection

  • Methylene blue 50 mg 1 pill 2 times a day (this is made by a compounding pharmacy). In one to two months, If there is an inadequate response, consider increasing to 2 pills 2 times a day.

Combine with one of the following to address growing spirochete and intracellular (L-form) forms of Lyme:

  • Azithromycin 500 mg 1 pill 1 time a day;
  • Clarithromycin 500 mg 1 pill 2 times a day;
  • Minocycline 100 mg 1 pill 2 times a day;
  • Doxycycline 100 mg 1 pill 2 times a day;

Combine with one of the following to address growing cyst forms of Lyme:

  • Grapefruit seed extract 250 mg 1 pill 2 times a day;
  • Fluconazole 200 mg 1 time a day;
  • Tinidazole 500 mg 1 pill 2 to 3 times a day; or
  • Metronidazole 500 mg 1 pill 2 to 3 times a day

Methemoglobinemia, Low Energy, Brain Fog and Cognitive Dysfunction

  • Methylene blue 50 mg 1 pill 2 times a day (this is made by a compounding pharmacy). In Methemoglobinemia, If there is an inadequate response and blue lips or shortness of breath remain, consider increasing to 2 pills 2 times a day. In an emergency with severe shortness of breath, go to the emergency room for IV methylene blue.

Additional Resources to Treat Persisters

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.


View Citations

  1. Li T, Feng J, Xiao S, Shi W, Sullivan D, Zhang Y. Identification of FDA-approved drugs with activity against stationary phase Bartonella henselae. Antibiotics (Basel). 2019;8(2):50. doi:10.3390/antibiotics8020050 (View)
  2. Boehmer M. Methylene Blue, A Deeper Look. International Lyme and Associated Disease Society member webinar; January 17, 2023.
  3. Feng J, Weitner M, Shi W, Zhang S, Sullivan D, Zhang Y. Identification of additional anti-persister activity against Borrelia burgdorferi from an FDA drug library. Antibiotics (Basel). 2015;4(3):397-410. doi:10.3390/antibiotics4030397 (View)
  4. Moorcroft M. Utilizing Methylene Blue in the Treatment of Chronic Infections. Lecture presented at the International Lyme and Associated Diseases Scientific Annual Conference; October 2023; Boston, MA. 
  5. Pfaffendorf M, Bruning TA, Batnik HD, van Zwieten PA. The interaction between methylene blue and the cholinergic system. Br J Pharmacol. 1997;122(1):95-98. doi:10.1038/sj.bjp.0701355 (View
  6. Tucker D, Lu Y, Zhang Q. From Mitochondrial Function to Neuroprotection-an Emerging Role for Methylene Blue. Mol Neurobiol. 2018;55(6):5137-5153. doi:10.1007/s12035-017-0712-2 (View)
  7. Zheng X, Ma X, Li T, Shi W, Zhang Y. Effect of different drugs and drug combinations on killing stationary phase and biofilms recovered cells of Bartonella henselae in vitro. BMC Microbiol. 2020;20(1):87. doi:10.1186/s12866-020-01777-9 (View)
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About The Author

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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