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Because of the severity of the interaction, in published drug databases (i.e UpToDate LexiDrug, Clinical Pharmacology, etc.), the interaction is listed as a Avoid Combination (X) and/or Level 1 (Contraindicated). For this reason, many patients and practitioners avoid the use of methylene blue 9-26

In the alkaline environment of the small intestine, R-proteins are degraded by pancreatic enzymes, freeing vitamin B 12 to bind to intrinsic factor (IF), a protein secreted by specialized cells in the stomach (parietal cells)

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