Methylene Blue — Dr. Rawls’ Ratings
Efficacy: 3.5 stars
Safety: 3.5 stars
Cost: 2 out of 5 dollar signs
Ways to Administer: Oral preparation
Bottom Line: Methylene blue has potential as a treatment for Lyme disease and coinfections, especially Bartonella. However, long-term results and side effects are still unknown.


Since it was first isolated as a chloride salt compound in the late 1800s, methylene blue (MB) has demonstrated a range of therapeutic benefits, including antidepressant, antimicrobial, antioxidant, and neuroprotectant properties. It was used to treat malaria for nearly 100 years, but it fell out of favor when chloroquine, a quinolone-based drug, emerged on the scene.

Presently, MB is used to treat a life-threatening condition known as methemoglobinemia, a serious blood disorder where not enough oxygen makes it to the cells, and urinary tract infections.

In recent years, researchers have begun to look at some of MB’s other uses – most notably, as an antimicrobial agent against Lyme disease and the coinfection Bartonella. It may also have some power against mold, viruses, and other pathogens and boost ATP levels in the body.

Two studies examined MB’s ability to treat Bartonella. A 2019 study showed that MB has power against persistent Bartonella infections when used alone or with other synthetic or herbal antimicrobials. Then, in 2020, the same group of researchers evaluated a panel of drug combinations and found that MB removed biofilms when used with other antibiotics. However, neither study was performed in human or animal models, so more research is needed to accurately assess its success as a treatment for Lyme or various strains of Bartonella.

Nevertheless, several healthcare professionals are using MB in their protocols, and some patients report improvements from the drug. Typically, the medication is administered in 50 mg doses twice daily, but it may vary depending on the provider. MB may also be used in lower doses as part of a protocol involving the use of red light therapy for deeper penetration of the drug in specific areas of the body.


Emerging research holds promise for using MB as a treatment for persistent Bartonella, so it’s reasonable to consider. MB contains antimicrobial properties, but because it isn’t an antibiotic, it doesn’t destroy the gut flora like synthetic antibiotics do. However, because MB has yet to be tested in humans, the long-term results and side effects are still unknown.


In therapeutic doses, MB is generally well-tolerated. However, it turns urine blue and can temporarily stain the mouth and teeth. It may also interact with several medications and supplements, so be sure to let your doctor know what you’re taking before starting MB therapy. Higher doses of MB can yield side effects such as chest pain or confusion. Additionally, it’s not unusual for patients to report experiencing Herxheimer reactions while taking the drug.


Most patients use the liposomal preparation of MB from a compounding pharmacy to increase the rate of absorption through the stomach, so the price can vary depending on the pharmacy and the length of time you take it, but expect to pay somewhere between $250 to $300 for a month’s supply.

Dr. Bill Rawls Treatment Guide

Dr. Bill Rawls’ Treatment Guide

Want to see more Lyme disease treatment ratings? See What Dr. Rawls has to say about popular treatments and therapies in his Lyme Disease Treatment Guide.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

1. Li T, Feng J, Xiao S, Shi W, Sullivan D, Zhang Y. Identification of FDA-Approved Drugs with Activity against Stationary Phase Bartonella henselae. Antibiotics (Basel). 2019;8(2):50. Published 2019 Apr 29. doi: 10.3390/antibiotics8020050
2. Zheng, X., Ma, X., Li, T. et al. Effect of different drugs and drug combinations on killing stationary phase and biofilms recovered cells of Bartonella henselae in vitro. BMC Microbiol 20, 87 (2020). doi: 10.1186/s12866-020-01777-9