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亞甲藍

Methylene Blue

Methylthioninium chloride

解毒劑 / 噻嗪類染料IV狗貓馬牛羊山羊

別名: Azul Metile · Collubleu · Desmoidpillen · Vitableu · Urolene Blue · Zumetil · Methylene Blue · Proveblue · Methylthioninium chloride · Azul de metileno · Blu di metilene · CI basic blue 9 · Colour index no. 52015 · Methylenii caeruleum · Methylthioninii chloridum · Schultz no. 1038 · Tetramethylthionine chloride trihydrate

由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本

經審核的 v13 劑量證據

經審核的非計算證據
經審核的非計算證據 (1)

僅供證據參考，不會自動計算

Nitrite and nitrate toxicoses

TABLE 128.6. Agent: Methylene blue. Dosage: 2 mg/mL bath to effect52. Species/Comments: Nitrite and nitrate toxicoses.

bath
高風險須由已驗證獸醫確認drug_regimen方案年份 2019審核 dose-audit-mader-reviewed-v1

劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。

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概覽

亞甲藍是一種​噻嗪類染料​，主要作為​解毒劑​，用於治療反芻動物因硝酸鹽或氯酸鹽等氧化劑引起的​變性血紅素血症 (Methemoglobinemia)​。它偶爾也作為氰化物中毒的輔助或替代療法。

在小動物醫學中，它被獨特地用作術中靜脈染色劑，以優先標記狗胰臟的​胰島細胞瘤 (Insulinomas)​，從而輔助外科切除。

​臨床要點：​ ​ 亞甲藍具有矛盾的劑量依賴性效應：在低劑量下，它作為還原劑治療變性血紅素血症；但在高劑量下，它作為氧化劑，反而會​導致*變性血紅素血症。

  • 貓對此藥物的氧化損傷極度敏感，因此在貓科動物中使用具高度爭議性，通常被視為禁忌。

作用機轉

Methylene blue acts as an artificial electron acceptor and donor in red blood cells.

  • ​Reduction Pathway:​ In the tissues, methylene blue interacts with the enzyme NADPH-methemoglobin reductase. It is rapidly reduced to leucomethylene blue.
  • ​Hemoglobin Conversion:​ Leucomethylene blue serves as a reducing agent (electron donor) → converts ​methemoglobin (Fe3+)​ back to functional oxygen-carrying ​hemoglobin (Fe2+)​.
  • ​Oxidation Pathway (High Doses):​ Methylene blue is inherently an oxidizing agent. If administered at high doses (species dependent), it overwhelms the reduction pathway and directly oxidizes hemoglobin → causes methemoglobinemia.

安全性與警告

禁忌症

  • Cats (considered contraindicated by most clinicians due to severe sensitivity)
  • Renal insufficiency
  • Hypersensitivity to methylene blue
  • Intraspinal (intrathecal) injection
  • Lactating dairy animals
  • Severe renal impairment
  • Patients with G6PD deficiency (can cause severe hemolysis)
  • Use with extreme caution in cats due to high susceptibility to Heinz body formation

不良反應

  • Red cell morphological changes
  • Decreased red blood cell life span
  • Necrotic abscesses (if injected SC or extravasated IV)
  • Green-blue discoloration of urine
  • Heinz body anemia (especially in cats)
  • Paradoxical methemoglobinemia (at high doses)
  • Tissue necrosis (if extravasated)
  • Blue/green discoloration of urine, feces, and mucous membranes
  • Nausea and vomiting

注意事項

​WARNING:​ Cats are highly sensitive to methylene blue and can rapidly develop Heinz body anemia and methemoglobinemia. Dogs and horses can also develop these effects at relatively low dosages.

  • ​Administration:​ Must be given IV. Extravasation or subcutaneous injection can cause severe necrotic abscesses.
  • ​Efficacy:​ Considered relatively ineffective in reducing methemoglobin in horses.
  • ​Food Animal Residues:​ FARAD recommends a minimum milk withdrawal time of 4 days. Meat withdrawal is conservatively recommended at 180 days due to carcinogenicity concerns, though some data suggest 14 days may be sufficient.
  • ​Pregnancy:​ FDA Category C. Safe use during pregnancy has not been demonstrated.

藥物交互作用

SSRIs (e.g., Fluoxetine)Major

Methylene blue is a potent reversible monoamine oxidase inhibitor (MAOI); concurrent use can precipitate fatal serotonin syndrome.

Tricyclic Antidepressants (TCAs)Major

Increased risk of serotonin toxicity.

監測

  • Methemoglobinemia levels
  • Red cell morphology
  • Red cell indices
  • Hematocrit
  • Methemoglobin levels
  • Complete Blood Count (CBC) for Heinz bodies and hemolysis
  • Arterial blood gas (ABG)
  • Renal function
  • Signs of serotonin syndrome if on concurrent serotonergic drugs

藥物動力學

半衰期

貓Unknown狗Unknown

吸收

Absorbed from the GI tract, but is usually administered parenterally in veterinary medicine.

分佈

Rapidly converted to leucomethylene blue in tissues.

代謝

Converted to leucomethylene blue, which serves as the active reducing agent.

排除

Excreted in the urine and bile, primarily in the colorless form, but some unchanged drug may also be excreted.

過量

The LD50 for IV administered 3% methylene blue is approximately 43 mg/kg in sheep. High doses can paradoxically cause methemoglobinemia due to the drug's inherent oxidizing properties.

可用產品

劑型

  • 1% (10 mg/mL) solution
  • Powder for compounding
  • Injectable: 10 mg/ml (1% solution)

獸醫用

  • 1% (10 mg/mL) methylene blue solution (Centaur) - labeled as a dye, laboratory indicator, and reagent
  • Methylene Blue, USP powder

人用標示

  • Methylene Blue Injection: 10 mg/mL in 1 mL & 10 mL ampules
  • Methylthioninium chloride 10 mg/ml (1%) injection (e.g., Proveblue)

各地核准狀態

European Union✓ 已核准處方藥EMA

POM (Prescription Only Medicine)

United Kingdom✓ 已核准處方藥VMD

POM (Prescription Only Medicine)

暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

儲存與穩定性

Store at room temperature unless otherwise instructed by the manufacturer. Physically incompatible when mixed with caustic alkalies, dichromates, iodides, and oxidizing or reducing agents.

飼主須知

  • ​專業監督：​ 由於此藥物具有潛在毒性，且變性血紅素相關中毒情況嚴重，必須在獸醫師的密切監督下使用。
  • ​染色問題：​ 亞甲藍可能會嚴重染污衣物或皮膚。若需清除，可使用次氯酸鹽溶液（漂白水）。
  • ​尿液顏色：​ 飼主應注意，在治療期間，動物的尿液可能會變成藍綠色。

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