Hello all.

Our organization is looking to build a methylene blue infusion in our EHR (EPIC).

According to the ProvayBlue package insert, methylene blue should only be prepared using D5W due to the potential risk of precipitation associated with reduced solubility in the presence of chloride ions.

The generic methylene blue 1% product does not list any diluent restrictions in its package insert and multiple published studies have mixed methylene blue in normal saline without reports of precipitation or adverse reactions. Stability studies do not appear to have been conducted in any of these references.

For those organizations that prepare methylene blue infusions using generic versions of the medication (i.e. not ProvayBlue specifically), do you allow its preparation in 0.9% sodium chloride or restrict it to only D5W?
If dilution in normal saline is permitted, what is the max concentration prepared?

Thank you.

Vee