Methylene Blue and Lyme

 

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 on antidepressants.

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 of drugs. 

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 therapy. 

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 way.  

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.