Inside the Electron Chain
Cell and animal studies show methylene blue accepting and donating electrons inside the electron transport chain.
Prescription · Clinical Monograph
Methylene Blue
An FDA-approved drug for a blood disorder. Prologue prescribes it off-label, at a much smaller dose, and screens for two specific risks first.
Methylene blue has been in medical use since the 1890s. The FDA approves it for methemoglobinemia, a condition where blood carries oxygen poorly. Prologue prescribes it off-label at a much smaller dose, for its activity in the mitochondrial electron transport chain.
Two safety issues put this drug behind a physician screen. Both are described below.
Cellular Energy
Prescribed off-label at a much smaller dose, for its activity in the mitochondrial electron transport chain.
1890s
Decades on the Record
Methylene blue has been in medical use since the 1890s.
What getting it involves
A G6PD result
Your G6PD status, which a blood test settles before a prescription is written.
A physician reads it
Your history and every medication you take, before prescribing.
Prescribed off-label
An FDA-approved drug for a blood disorder, prescribed off-label at a much smaller dose.
Where the evidence stands
Preclinical
Cell and animal studies show methylene blue accepting and donating electrons inside the electron transport chain, which is a plausible mechanism.
Small
Human trials at low doses are small and short.
Anyone describing this as settled science is running ahead of the literature.
What your physician screens for
G6PD deficiency
Methylene blue can trigger hemolytic anemia in people who carry this enzyme deficiency. It is one of the most common enzyme deficiencies in the world and runs higher in men of African, Mediterranean, and South Asian descent. A blood test settles the question before a prescription is written.
Serotonin syndrome
Methylene blue is a potent inhibitor of monoamine oxidase. Combined with an SSRI, SNRI, or MAOI, that raises the risk of serotonin syndrome, which is serious and occasionally fatal. The FDA issued a drug safety communication on this in 2011. Your physician reviews every medication you take before prescribing.
These two risks are specific to methylene blue. The consultation also covers your full medical history, and your physician may ask for recent lab results depending on what they find.
How it's prescribed
There's no standard dose for this use. The range in the published literature is wide, and the right amount for you depends on your lab results, your other medications, and how you respond. Your physician sets it and reviews it at your follow-up.
Compounded by a licensed pharmacy partner and tested for potency, sterility, and endotoxin levels before shipment.
PotencySterilityEndotoxin
Disclosures
Methylene blue is FDA-approved for methemoglobinemia. Prologue prescribes it off-label for longevity indications. It is compounded by a licensed pharmacy partner and tested for potency, sterility, and endotoxin levels before shipment. Treatment is not appropriate for every patient, and outcomes vary. Talk with your physician about whether this fits your situation.
Begin
How to get it.
Methylene blue requires a consultation with a Prologue physician.
Everyone else starts by joining the practice.
Members can bring it up at their next consultation.
Questions
Nothing is charged when you join. Billing begins only after a physician has approved your plan. If they decide treatment isn't appropriate for you, you are not charged.
Standard shipping for oral medications. Cold-chain shipping for injectables.
Protocol adjustments happen as your response shows up. If the dose or cadence changes, your next shipment reflects the change. There is no additional fee for protocol adjustments within your existing protocol.
Refills go out on the cadence your physician sets, without you having to ask.
Not listed here? Read the full FAQ.