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Methylene blue is theorized to provide hemodynamic support by combating the nitric oxide (NO) induced vasodilation in amlodipine overdose by acting as a NO scavenger, preventing NO production, and impeding cGMP production.[20] While there have been reports of hemodynamic improvements in those with refractory shock, the overall evidence behind its benefit is sparse.[20,22,3,5] Other treatments that have been described but not well studied included sodium bicarbonate infusion (thought to work by correcting the acidosis that enhances calcium channel blocker binding to L-type calcium channels), phosphodiesterase III inhibitors, levosimendan, L-carnitine, and mechanical support with an intra-aortic balloon pump.[5,23] Overall, these modalities are not recommended as the evidence supporting them is lacking, but they can be considered as a last resort in those not responding to the therapies previously described above