Which medications are used in the treatment of mild chronic methemoglobinemia due to enzyme deficiencies?

Updated: Dec 09, 2018
  • Author: Mary Denshaw-Burke, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Patients with mild chronic methemoglobinemia due to enzyme deficiencies may be treated with oral medications in an attempt to decrease cyanosis. These medications include methylene blue, ascorbic acid, and riboflavin. The methylene blue dosage in this setting is 100-300 mg/day, which may turn the urine blue in color. The ascorbic acid dosage is 200-500 mg/day; unfortunately, long-term oral ascorbic acid therapy can cause the formation of sodium oxalate stones. The riboflavin dosage is 20 mg/day.

Cimetidine can be used in dapsone-induced methemoglobinemia to prevent further formation of its metabolite. N-acetylcysteine has been shown to reduce methemoglobin in some studies but is not currently an approved treatment for methemoglobinemia.

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