Drug & supplement interaction

Methylene Blue + Esomeprazole

Esomeprazole brand name: Nexium.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between Methylene Blue and Esomeprazole in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the label for Esomeprazole states a food rule worth keeping to, and the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Methylene Blue and Esomeprazole

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Esomeprazole and Methylene Blue in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Methylene Blue safety at a glance

Methylene Blue overall Use caution It is a real drug with real risks; medical-grade forms need supervision and it should not be self-dosed casually.
Pregnancy Likely Unsafe PREGNANCY: Likely Unsafe when prescription methylene blue is used intra-amniotically. When provided during the second trimester, methylene blue has caused fetal... Read the full pregnancy detail
Breastfeeding Possibly Unsafe LACTATION: Possibly Unsafe when prescription methylene blue products are administered to patients who are lactating. Breast-feeding should be discontinued durin... Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Esomeprazole and Methylene Blue? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Esomeprazole

Interactions in our licensed database are recorded against drug classes, not just single drug names. Esomeprazole is filed under 6 classifications — including proton pump inhibitors (ppis), cytochrome p450 2c19 (cyp2c19) inhibitors, cytochrome p450 1a2 (cyp1a2) inducers. Methylene Blue has documented interactions with 2 drug classes — the most serious being anticholinergic drugs (moderate) and serotonergic drugs (moderate) — and none of Esomeprazole’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Methylene Blue Does Interact With Other Medications

Methylene Blue has 315 moderate known drug interactions in our database — Esomeprazole isn’t one of them. If you take anything else, check it against the full list below.

Moderate 315 No known interaction 2,515 (incl. Esomeprazole)
Taking anything else?

Check Another of Your Medications Against Methylene Blue

Covers the 2,830 medications we’ve checked against Methylene Blue. Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests Methylene Blue and Esomeprazole May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do. 10 of them are worth acting on rather than waiting out — marked below.

  • Low magnesium / Low potassium Worth acting on Additional detail

    Methylene Blue

    “Orally: Abdominal pain, blue/green urine, diarrhea, dysuria, fecal discoloration, headache, nausea, and vomiting. Intravenous: Blue skin, diarrhea, dysuria, headache, hypokalemia, hypomagnesemia, myoclonus, and nausea.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in general.

    “Orally, methylene blue has resulted in dose-dependent reductions in red cell count and hemoglobin, occasionally with anemia, and increases in methemoglobin. The rate of having methemoglobin levels greater than 3.5% during treatment was 1.3%. In another clinical trial, there was a case of megaloblastic anemia requiring vitamin B12 injections following use of methylene blue.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in hematologic.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • Pain or burning when passing urine Worth acting on Additional detail

    Methylene Blue

    “Orally, common adverse effects include blue or green urine and urethritis. Increased frequency of urination and urinary tract burning have also been reported. Blue urine has also occurred when methylene blue is given for chromopertubation during laparoscopy. When used intravenously, dysuria has been reported.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in genitourinary.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • Yellowing of the skin or eyes Worth acting on Additional detail

    Methylene Blue

    “Orally, methylene blue has rarely resulted in mild-to-moderate acute increases in alanine transaminase, aspartate transaminase, or gamma-glutamyl transferase. Intravenously, methylene blue has resulted in elevated bilirubin and liver enzymes.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in hepatic.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • Confusion Worth acting on Additional detail

    Methylene Blue

    “Orally: Hemolytic anemia, methemoglobinemia. Intravenous: Altered mental status, anaphylaxis, death, extravasation, hemolytic anemia, hypertension, methemoglobinemia, palpitations, phototoxicity, seizure-like symptoms, and tachycardia.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in general.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • A severe skin reaction Worth acting on Additional detail

    Methylene Blue

    “When used intravenously, blue skin, necrotic ulcers, papules, and phototoxicity have been reported. Extravasation has occurred following intravenous infusion of methylene blue. In one case, blistering and skin irritation occurred. Intraparenchymally, redness, broken blood vessels, and skin necrosis have been reported rarely.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in dermatologic.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • Anemia Worth acting on Additional detail

    Methylene Blue

    Recorded for Methylene Blue in the same Natural Medicines adverse-effect record shown under Confusion above.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • Raised blood pressure Worth acting on Additional detail

    Methylene Blue

    “When used intravenously, hypertension, palpitations, and tachycardia have been reported.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in cardiovascular.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • A severe allergic reaction Worth acting on Additional detail

    Methylene Blue

    “An anaphylactic-like reaction to methylene blue, requiring epinephrine, has been reported in an infant during surgery . However, skin-prick testing was negative. In a case report, a 44-year-old female developed a systemic allergic reaction with acute pulmonary edema following subcutaneous injection with methylene blue.”

    Methylene Blue · Natural Medicines adverse-effect record, reported in immunologic.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

  • Hives Worth acting on Additional detail

    Methylene Blue

    Recorded for Methylene Blue in the same Natural Medicines adverse-effect record shown under A severe allergic reaction above.

    Esomeprazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Esomeprazole. Read the label on DailyMed ›

Showing the 10 most notable of 26 shared effects — ranked by how unusual each one is, not just whether both lists mention it.

Reported for Methylene Blue but not commonly for Esomeprazole: eye irritation or redness and seizures.

Effects for Esomeprazole come from the ADVERSE REACTIONS section of its FDA label; effects for Methylene Blue come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 235,235 voluntary FDA FAERS reports for Esomeprazole that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Methylene Blue in Pregnancy & Breastfeeding

Adults Likely Safe

Likely Safe when prescription methylene blue products are used intravenously and appropriately, short-term. Methylene blue is available as an FDA-approved prescription product. There is insufficient reliable information available about the safety of any form of supplemental or non-prescription methylene blue product.

Children Likely Safe

CHILDREN: Likely Safe when prescription methylene blue products are used intravenously and appropriately, short-term. Methylene blue is available as an FDA-approved prescription product. Cases of hemolytic anemia, hyperbilirubinemia, and acute renal failure have occurred rarely in neonates. CHILDREN: There is insufficient reliable information available about the safety of any form of supplemental or non-prescription methylene blue product.

Pregnancy Likely Unsafe

PREGNANCY: Likely Unsafe when prescription methylene blue is used intra-amniotically. When provided during the second trimester, methylene blue has caused fetal intestinal atresia and death. When used close to term, adverse effects have been reported in the newborn including hemolytic anemia, hyperbilirubinemia, methemoglobinemia, photosensitivity, and respiratory distress. Phototherapy and blood exchange transfusion have been required. PREGNANCY: There is insufficient reliable information available about the safety of methylene blue given by intrauterine injection during the first trimester. Inadvertent exposure in 4 case reports has not resulted in adverse effects. PREGNANCY: There is insufficient reliable information available about the safety of oral supplemental or non-prescription methylene blue products. However, fetal toxicity, including fetal loss, malformations, and reduced fetal weight, has been observed in animal studies at high doses.

Lactation Possibly Unsafe

LACTATION: Possibly Unsafe when prescription methylene blue products are administered to patients who are lactating. Breast-feeding should be discontinued during and for 8 days after treatment. LACTATION: There is insufficient reliable information available about the safety of oral supplemental or non-prescription methylene blue products.

Safety ratings from the Natural Medicines database. If you are pregnant or nursing, review any supplement with your OB or pharmacist first.

How to take them

Some Esomeprazole Products Have a Food Rule — Methylene Blue Should Not Break It

At least one FDA label for a product containing Esomeprazole says to take it on an empty stomach. Most supplements — Methylene Blue included — are taken with a meal, so the easy mistake is swallowing both together at breakfast. Where that rule applies, keep Esomeprazole on its own and move Methylene Blue to a meal later in the day.

This may not be true of your version. Food instructions belong to the product, not the ingredient: two Esomeprazole products can carry different directions, and extended-release forms often differ from immediate-release ones. The label we read is quoted below — check the directions on your own box or bottle, or ask your pharmacist, for how to take the exact product you were given.

Table 2: Recommended Dosage of Esomeprazole Magnesium Delayed-Release Capsules in Pediatric Patients by Indication Indication Patient Age Recommended Dosage Duration Healing of EE 12 years to 17 years Esomeprazole magnesium delayed-release capsules: 20 mg or 40 mg once daily 4 to 8 Weeks Treatment of Symptomatic GERD 12 years to 17 years Esomeprazole magnesium delayed-release capsules: 20 mg once

From the Dosage and Administration section of the FDA label we read for Esomeprazole — where that label names a specific product, the instruction is that product's. Read the label on DailyMed ›

A food rule is not an interaction — it is about how much of the medicine you absorb. The directions that came with your own product, and your pharmacist, outrank anything on this page.

From our Q&A

Questions About Methylene Blue or Esomeprazole

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Methylene Blue or Esomeprazole, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Esomeprazole

This page covers Methylene Blue only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Esomeprazole page lists 154 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 102 moderate · 49 minor.

From our pharmacist’s overview on the Esomeprazole page

“St. John's wort can lower the amount of esomeprazole (Nexium) in your blood by speeding up how the liver clears it, which can leave heartburn or ulcer treatment falling short.”

Reviewed by 2 · Jul 18, 2026

Open the Esomeprazole interaction page

How much people look this up

Where Methylene Blue and Esomeprazole Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Methylene Blue
Top 25%

#268 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Esomeprazole
Top half

#743 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Methylene Blue reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Methylene Blue and Esomeprazole records this page draws on were last updated July 16, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Methylene Blue

What is Methylene Blue?

Methylene Blue
  • Methemoglobinemia (a blood disorder)
  • Claimed energy or mental focus support
  • Anti-aging or longevity claims
  • Antimicrobial or antimalarial uses (historical)
  • Dye for medical and lab procedures

Methylene blue is a synthetic dye that is an FDA-approved prescription medicine for a rare blood disorder called methemoglobinemia, and it is also used as a diagnostic dye. Its popular use as a supplement for energy, brain health, or anti-aging is not well supported by solid human evidence, and it can cause serious side effects. Talk to a pharmacist or doctor before using it, and never take non-pharmaceutical or industrial-grade products.

Synthetic chemical compound (not derived from a plant) · Prescription injection, oral tablets, and compounded liquid or capsule supplements

An interaction check asks whether these two react with each other — it does not ask whether Methylene Blue is a good idea for someone in your situation. Here is what our Methylene Blue record says about it on its own.

Methylene Blue: dosing

There is no established safe supplement dose of methylene blue. In hospitals, medical doses are carefully calculated by weight and given by trained staff, which is very different from taking it on your own.Supplement products vary widely in strength and quality, and some sold online are not intended for people. If you are considering methylene blue, do not guess at a dose. They can review your health conditions and all your medicines to help you decide whether it is safe for you.

From our Methylene Blue monograph — the full record covers uses, side effects and every documented interaction.

Read the full Methylene Blue monograph & all interactions
Medication

About Esomeprazole

What Is Esomeprazole Used For?

Brand name: Nexium

Esomeprazole treats problems caused by excess stomach acid. It's used to heal erosive esophagitis (damage to the esophagus from acid), control GERD (gastroesophageal reflux disease) symptoms like heartburn, and protect the stomach lining in people at risk for ulcers caused by NSAIDs (anti-inflammatory pain relievers like ibuprofen).

It's also used as part of a three-drug combination to wipe out H. pylori — a stomach bacteria linked to ulcers — and for people with rare conditions that cause the stomach to overproduce acid, such as Zollinger-Ellison syndrome.

Most-Reported Side Effects for Esomeprazole

From FAERS, the FDA’s public side-effect reporting system (235,235 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Chronic kidney disease 35,589 reports
Acute kidney injury 20,510 reports
Renal failure 16,295 reports
Nausea 13,667 reports
Gastrooesophageal reflux disease 12,006 reports
See full Esomeprazole drug information
Keep checking

Other Drugs & Methylene Blue

Browse every other medication we’ve checked against Methylene Blue — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
315Moderate
0Minor
2,514No known interaction
315 Moderate 2,514 No interaction
Moderate

315 interactions

Showing 60 of 315 moderate interactions — see all 315 on the Methylene Blue page.

No interaction 2,514 drugs checked — show the list

We also checked Methylene Blue against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,514 medications checked with no known interaction — see the full Methylene Blue list.

See the full Methylene Blue interactions page
See every supplement checked against Esomeprazole, ranked by severity
Evidence & sources

Methylene Blue References

The 60 references that drive our Methylene Blue monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Chebolu E, Gnirke M, St Francis H, Soghoian S, Su MK. Extravasation with methylthioninium chloride. Clin Toxicol (Phila) 2024;62(11):776-778. PubMed
  2. Walter-Sack I, Rengelshausen J, Oberwittler H, et al. High absolute bioavailability of methylene blue given as an aqueous oral formulation. Eur J Clin Pharmacol. 2009;65(2):179-89. PubMed
  3. Akazawa M, Wu YH, Liu WM. Allergy-like reactions to methylene blue following laparoscopic chromopertubation: A systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2019;238:58-62. PubMed
  4. Aldeghaither S, Deschênes PJF, Samoukovic G. Anticholinergic Toxidrome as a Possible Explanation for Methylene Blue Toxicity. Am J Case Rep 2023;24:e941453. PubMed
  5. Liao YP, Hung DZ, Yang DY. Hemolytic anemia after methylene blue therapy for aniline-induced methemoglobinemia. Vet Hum Toxicol 2002;44(1):19-21.
  6. Bilgin H, Ozcan B, Bilgin T. Methemoglobinemia induced by methylene blue pertubation during laparoscopy. Acta Anaesthesiol Scand 1998;42(5):594-5. PubMed
  7. Kirlangitis JJ, Middaugh RE, Zablocki A, Rodriquez F. False indication of arterial oxygen desaturation and methemoglobinemia following injection of methylene blue in urological surgery. Mil Med 1990;155(6):260-2. DOI
  8. Porat R, Gilbert S, Magilner D. Methylene blue-induced phototoxicity: an unrecognized complication. Pediatrics 1996;97(5):717-21. DOI
  9. Honoré PJ, Deianova N, Loret G, Hemelsoet D. An easily overlooked cause of toxic encephalopathy: methylene blue in a patient on an SSRI. Acta Neurol Belg 2018;118(1):121-122. PubMed
  10. McRobb CM, Holt DW. Methylene blue-induced methemoglobinemia during cardiopulmonary bypass? A case report and literature review. J Extra Corpor Technol 2008;40(3):206-14. DOI
  11. Donaldson CJ, Sequeira Campos M, El-Sayed M. Inadvertent foetal exposure to methylene blue in the first trimester. J Obstet Gynaecol 2020;40(4):573-574. PubMed
  12. Vanhinsbergh L, Uthaya S, Bain BJ. Methylene blue-induced Heinz body hemolytic anemia in a premature neonate. Am J Hematol 2018;93(5):716-717.
  13. Repici A, Di Stefano AF, Radicioni MM, Jas V, Moro L, Danese S. Methylene blue MMX tablets for chromoendoscopy. Safety tolerability and bioavailability in healthy volunteers. Contemp Clin Trials 2012;33(2):260-7. PubMed
  14. Lee DC, Valente JH. Methylene blue dye-induced knee effusion. Am J Emerg Med 1999;17(7):739-40. PubMed
  15. Albert M, Lessin MS, Gilchrist BF. Methylene blue: dangerous dye for neonates. J Pediatr Surg 2003;38(8):1244-5. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Methylene Blue and Esomeprazole Together: Common Questions

Is it safe to take Methylene Blue with Esomeprazole?
We do not list a known interaction between Methylene Blue and Esomeprazole. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Methylene Blue and Esomeprazole have any of the same side effects?
Yes — our sources link each of them separately to 10 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Should I take Methylene Blue and Esomeprazole at the same time of day?
At least one FDA label for a product containing Esomeprazole says to take it on an empty stomach, and supplements are usually taken with a meal — so taking them together at breakfast is the easy mistake. Where that applies, keep Esomeprazole on its own and move Methylene Blue to a meal later in the day. Food instructions belong to the product rather than the ingredient, so check the directions on your own box. This is about absorption, not an interaction.
How was the Methylene Blue and Esomeprazole combination checked?
Interactions in our licensed database are recorded against drug classes. Esomeprazole is filed under 6 classifications, and Methylene Blue has documented interactions with 2 drug classes — none of Esomeprazole's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Methylene Blue interact with any other medications?
Yes. Methylene Blue has 315 documented drug interactions in our database — Esomeprazole is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Esomeprazole interact with any supplements?
Yes. Esomeprazole has documented interactions with 154 supplements in our database — Methylene Blue is not one of them. The Esomeprazole interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Methylene Blue monograph Uses, safety profile, and every drug interaction in one place Esomeprazole drug information The full plain-English guide to this medication Esomeprazole supplement interactions Every supplement checked against Esomeprazole, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 60 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Esomeprazole and Methylene Blue?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.