Methylene Blue

[bimalc]

Any one with experience in the use of Methylene Blue for hypotension refractory to multiple pressors?

[Hamed]

No experience at all using it here, but I know its an old inhibitor of nitric oxide used in refractory vasoplegia.

[Jose Ramon Fernandez]

I have no experience with this drug. I attach one letter to editor (is in spanish but you can get some references from it). 

http://www.analesdepediatria.org/es-azul-metileno-utilidad-el-tratamiento-articulo-S1695403310005527

[bimalc]

On 6/27/2018 at 2:12 AM, Hamed said:

No experience at all using it here, but I know its an old inhibitor of nitric oxide used in refractory vasoplegia.

Yes; I'm familiar with its use in this context from a cardiac unit I used to work in and I know it has been used in PICU for refractory hypotension with at least case reports of success, but I have not seen any data for use in neonates.  When I have proposed its use in extreme cases in my current NICU, everyone is concerned that the nitric oxide inhibition will precipitate pulmonary hypertensive crisis.