Table 1.

Use of methylene blue in septic shock: pros and cons

PROS	CONS
Different mechanism of action than adrenergic agents (blocks sGC activity)	Neutral effect or increased mortality in clinical trials of non-selective NO inhibitors in septic shock
Effectively increases vascular tone and arterial pressure	Other agents can also achieve this
Enables other vasopressor (norepinephrine) doses to be reduced	Lack of evidence that this is truly a beneficial effect
Easy application with a continuous infusion	No clear understanding of dosage and timing of administration in relation to norepinephrine administration
Maintains cardiac contractility	Lack of increase in cardiac output and oxygen delivery
Low-cost	Catecholamines are quite cheap too
Widely available	No clear safety profile

sGC: soluble guanylate cyclase