Is there a magic bullet and is it methylene blue? Methylene has been shown to have activity against
malaria/Babesia, Bartonella and Lyme. It
has activity against persister forms of Bartonella and Lyme (borrelia) as well
as biofilms. It is active against coronavirus
(Covid). It has neuroprotective effects,
inhibits tau proteins in the brain and therefore may help fight Alzheimer’s
disease and other neurodegenerative brain disorders. It has been used with
photodynamic therapy to treat cancer, including lung and breast malignancies.
The drug is also known to strong psychoactive properties and has been shown to
benefit patients with psychiatric illness, including bipolar disorders.
It has serotonergic effects and cannot be taken by patients
The drug was developed in the late 1800s. No patents, no money, and no research--may be a problem. It is not commercially available (orally),
but capsules are prepared by some compounding pharmacies.
The most common use in the past century has been the
treatment of methemoglobinemia, a relatively rare condition in which oxygen
carrying hemoglobin is converted to a non-active form, generally a genetic disorder
trigged by an outside agent.
It sounds like the MacGyver of drugs – or Swiss army knife
Lyme patients are not infrequently desperate, suffering
despite much standard and experimental therapy, looking for the next thing.
The question is: Is methylene blue (MB) safe and effective for
chronic Lyme patients? Is it finally the Holy Grail?
First off, MB has been shown to be safe and effective in
humans (malaria). It was the first
synthetic anti-malaria drug, preceding commercial penicillin by about 50
years. Recent studies employ high doses
of the drug administered over 3 days. Malaria has become more resistant to a
wide array of therapies and MB has been resurrected and dusted off as if it is
something new. Short term use does not provide
cover for long-term usage, the hallmark of Lyme and associated diseases
Effectiveness for Lyme patients is inferred from in vitro (test tube) studies (Lyme, Bartonella, Babesia).
Methylene blue has broad spectrum antimicrobial activity against protozoans, bacteria and virus. Generally I prefer narrow spectrum drugs. A scorched earth drug may be problematic. I don't think we know anything about its effect on the microbiome, especially with prolonged use.
MB is undergoing clinical in
vivo trials for the treatment of Covid. This adds a log to the evidential fire
of drug safety. The Covid trials employ
low doses, MB 100 mg twice daily but for only 5 days. Malaria trials have used
higher doses but only for 3 days--10 mg/kg for 2 days followed by of 5 mg/kg
for one day. For example, a typical 70
kg man receives 700 mg for 2 days followed by 350 mg on the third day.
It should be clear that long-term clinical use for non-studied
infections is entirely experimental. But at this point there are numerous anecdotal
reports which praise MBs efficacy and appear to support safety when used this
I spoke at length with a patient today who is a big fan. He
has tried various doses and found 200-400 mg per day to be an effective dose.
He has found it works well only as part of cocktail therapy. One therapy, Zithromax, Rifampin and MB worked
well for Bartonella. For Babesia it has
been effective when combined with artemisinin (or Coartem) and primaquine (or tafenoquine).
MB is now part of the Lyme disease armamentarium. It has been in common use,
in some corners for more than 2 years. Treatments must always be individualized.
If the drug is used, I recommend starting with a low dose
like 50 mg twice daily and gradually increasing as tolerated.
All drugs have numerous side effects and drug interactions. Please do not purchase MB on the internet and treat yourself. The consequences could be disastrous. Don't have a fool for a doctor and a fool for a patient.
Methylene blue plays an increasingly important role in the management of tickborne disease and may ultimately have other important clinical applications.