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Beyond this narrow indication, methylene blue is widely employed off-label for intraoperative sentinel lymph node mapping, ifosfamide-induced neurotoxicity, and refractory vasoplegic (distributive) shock, with additional investigational uses in neuroprotection (Alzheimer disease, stroke, traumatic brain injury), psychiatric disorders (as a monoamine oxidase inhibitor), and even historical antimalarial therapy

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Injectable protocols deliver copper peptides systemically, affecting all tissues including those unreachable by topical application

Additionally, it requires that most of the drug is excreted in its unchanged form through the urine