Methylene Blue as Rescue Therapy in Refractory Hypotension Following Minoxidil Overdose

This document presents a case study of a 19-year-old male who experienced severe hypotension after ingesting approximately 180 mL of 5% topical minoxidil, a hair loss treatment. Despite being alert, the patient did not respond to standard treatments such as fluid resuscitation and vasopressors. The overdose led to vasoplegic shock due to minoxidil's vasodilatory effects, which are resistant to conventional therapies. Methylene blue was administered, resulting in rapid improvement of mean arterial pressure (MAP) and successful weaning off vasopressors. The patient was discharged after three days. This case highlights methylene blue's potential as an effective adjunctive therapy in reversing minoxidil-induced vasoplegia by inhibiting the nitric oxide–cGMP pathway, restoring vascular tone when standard treatments fail. Early recognition and intervention with alternative therapies are crucial in managing such toxicologic emergencies.