Document Type: SHORT COMMUNICATION

Authors

1 Associate Professor, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate Professor, Department of Anaesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Professor, Anaesthesiology and critical care lung research centre, Faculty of Medicine, Mashhad, Iran

4 Student, Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

5 PhD Student, Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

The severe acute respiratory syndrome caused by COVID-19 is now a global catastrophic event. Currently there
is no approved drug or vaccine for the disease. Methylene blue (MB, oxidized form, blue color) has been used in
many different areas of clinical medicine, ranging from malaria to orthopedics. Leucomethylene Blue (reduced form
of MB, colorless) may be applied for the treatment of COVID-19 according to the scientific evidences. In severe
patients, there is a cytokine storm (hyperinflammation) and high oxidative stress (OS). Inflammation and OS has
a mutual correlation and exacerbate each other. In human body, MB first induces OS through absorbing electron
(like a free radical) from other molecules, if the body could counteract to this OS, then reduced MB decreases
OS through other mechanisms. Reduced MB could prevent inflammation, propagation of the virus RNA, and also
improves hypoxia through reducing methemoglobin. Therefore, to avoid the increment of OS, we suggest using
Leucomethylene Blue through the following protocol: The IV cocktail contains 50 mg MB (1mg/kg, 50-kg weight),
1000-2000 mg vitamin C, 500-1000 mg N-Acetylcysteine (or glutathione or cysteine or α-lipoic acid) and 10-20 gr
urea (optional) in 100 ml dextrose 5%. Before the injection, the cocktail should be kept in a dark place for 1-2 hour
to become fade or colorless.
Level of evidence: V

Keywords