Focus on the “How to” of Methylene Blue (MB) for use by patients, (and family, friends, yourself, etc.) who want better attention, concentration, and memory.

So, you now know that many cognitive disorders like ADHD are cellular metabolic disorders based on mitochondrial dysfunction. (If you missed it, get that first issue, and read it now). You are probably eager to find a better solution for the many people who need treatment for ADHD and are unhappy with the well-known crises of use, misuse, and unavailability of current treatments.

NOW, what do you and your patients need to know as you explore with them a “First Start” or a “Fresh Start” using MB? Here are the questions and answers you and they need.

HOW DOES MB WORK?

MB is a Mitochondrial Booster! Mitochondria are well known as the “power plants of the cell” (every cell except red blood cells). They do this by converting the energy stored in the food we eat into ATP that the body uses for all its energy needs. When mitochondria are not functioning well, MB provides an alternative pathway by which mitochondria can continue to generate ATP in a more efficient way.

In addition, MB is an important antioxidant that neutralizes reactive oxygen species and reduces inflammation which are primary toxic contributors to mitochondrial and cellular dysfunction. If untreated, mitochondrial dysfunction may continue to further impair cells and contribute to chronic mental and medical diseases.

ADHD has clearly documented evidence of mitochondrial dysfunction, so it is not surprising that MB should improve attention, concentration, learning, and memory. In addition, it promotes wellness not only in brain cells but also in bodily cells at the same time. MB is truly a wellness agent for Mind and Body!

IS IT SAFE?

MB is remarkably safe at the oral doses used to treat mitochondrial dysfunction. MB has been used medically for over 100 years. This has generally been at much higher doses when given by IV with peak concentrations 10 to 50 times higher than the oral doses I recommend. The NIH states that MB is safe under 2 mg./kg of body weight. However, its use for neuropsychiatric conditions shows significant benefit at 0.25 mg/kg-0.5 mg/kg. At these doses, there are rarely noticeable side effects except those related to its staining properties. Remind them that it turns their urine blue which is not toxic in any way, and may actually suppress UTIs without causing antibiotic resistance.

IMPORTANT THINGS TO KNOW AND SHARE.

• No prescription is needed. It is inexpensive and available online. Some clinics and health stores have it available for purchase.
• Don’t use in pregnancy or lactation/breastfeeding. Concerns were the result of high doses given by IV, but there is insufficient safety information to comfortably recommend it on the low oral doses I recommend.
• Use in children under 4 is not recommended.
• It has no clinically significant drug-drug interactions. It is not an inducer or inhibitor of CYP enzymes and is metabolized by multiple CYP enzymes. It is primarily metabolized via conjugation via multiple UGT pathways. 40% is excreted unchanged in urine.
• It is a reversible monoamine oxidase A inhibitor and not the irreversible MOAI antidepressants that generated the initial concern about serotonin syndrome. Methylene blue alone has known antidepressant and anti-anxiety properties, so lowering, tapering, and even stopping the antidepressant may be a good option. The warning regarding use with SSRIs or SNRIs was from reports using much higher doses of methylene blue via IV infusions, where peak concentrations are much higher than when given orally. The lowest reported dose of methylene blue used with an SSRI that caused a serious serotonin syndrome was given IV at 5 mg/kg (about 350 mg/day for the average adult),far above the oral dose I recommend (.25 mg/kg). As a result, there is no risk of a serotonin syndrome from oral use at the dose I recommend.
• It has a 5-7 hour half-life, so once daily dosing in the morning, or dividing the dose with half in the morning and half in the evening, is recommended. This short half-life (the time half of the methylene blue is eliminated from the body) combined with its reversible action, and then further reduced when dosing is done twice a day, substantially reduces the risk of side effects and removes the risk of a serotonin syndrome. Interestingly, methylene blue does not cause the anxiety, agitation or mental rigidity seen with stimulants, and does not impair sleep at the dose I recommend, even when given late in the day.
• Finally, it is not habit-forming and has NO potential for abuse. It is available without a prescription online. I recommend ADHD 365 (tablets contain 2.5 mg each and can be dosed progressively higher adjusted to optimal results, or NeuroPro Plus which has 15 mg in each tablet.
• Because of its mitochondrial protective properties, it would be good if people DID develop a habit of taking MB every day along with lifestyle activities that also support cellular/mitochondrial health (nutrition, exercise, mindfulness, social connection, and quality sleep).

Until next time, this is Dr. Noel Gardner MD, wishing you many successful First Starts and Fresh Starts with MB, and encouraging you and those you care about and for to live in the “Blue Zone”!

Noel Gardner M.D., M.Div.