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It is a thiazine dye that is used intravenously (a single dose of 1-2 mg/kg, maximum 100 mg)) in the treatment of methemoglobinemia (secondary to nitrites, anilines, cyanides and other toxins), neurotoxicity due to ifosfamide, refractory vasoplegic shock and, locally, in diagnostic or surgical procedures (detection of fistulae, sentinel lymph node biopsy, and parathyroid gland staining). It is also an antiseptic component in preparations for topical application to the eyes, mouth, pharynx and skin. (Martindale, Pushparajah 2021)
Since the last update we have not found published data on its excretion in breastmilk.
The paucity of known pharmacokinetic data does not allow prediction of possible excretion in breast milk.
Authorized use in Pediatrics, including newborns. (1-2 mg/kg).
Given the low plasma levels of methylene blue after a treatment dose (Shah-Khan 2012, Repici 2012, Pruthi 2011, Gillman 2011), the maximum concentration that it would reach in breast milk would imply a theoretical dose for the infant that is much lower than that used in Pediatrics.
Avoid it on those patients suffering of G-6-P dehydrogenasa deficiency. Monitor premature or infant less than 1 month for side-effects (haemolysis and jaundice). (WHO 2002)
TOPICAL USE:
The small dose and poor plasma absorption of most topical ophthalmological preparations make it unlikely that significant amounts will transfer into breastmilk. Topical use of Methylene blue is compatible with breastfeeding.