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World J Clin Cases. May 6, 2026; 14(13): 117947
Published online May 6, 2026. doi: 10.12998/wjcc.v14.i13.117947
Published online May 6, 2026. doi: 10.12998/wjcc.v14.i13.117947
Methylene blue - an emerging vasopressor
Tapesh Bansal, Department of Intensive Care and Medicine, Paras Hospitals (former), Gurgaon 122002, Haryana, India
Author contributions: Bansal T concept, write and edit the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Tapesh Bansal, Department of Intensive Care and Medicine, Paras Hospitals (former), C 43 Sushant Lok, Gurgaon 122002, Haryana, India.
Received: December 22, 2025
Revised: February 14, 2026
Accepted: April 1, 2026
Published online: May 6, 2026
Processing time: 125 Days and 11.8 Hours
Revised: February 14, 2026
Accepted: April 1, 2026
Published online: May 6, 2026
Processing time: 125 Days and 11.8 Hours
Core Tip
Core Tip: Methylene blue (MB) is a mechanistically rational adjunct vasopressor that targets nitric oxide (NO)-mediated vasodilation in septic shock. When used early and within safe cumulative dose (≤ 4 mg/kg), it consistently reduces vasopressor requirements without toxicity. Unlike non-selective NO synthase inhibitors, MB selectively modulates the NO-guanylate cyclase-cyclic guanosine monophosphate pathway by inhibiting only the inducible NO synthase isoform of NO synthase, preserving physiological constitutive functions. Current evidence supports its use as an adjunct rather than rescue therapy, pending results from ongoing randomized trials. In this narrative review we present the facts and data on MB with no fluff!