methenamine/hyoscyamine (Rx)

Brand and Other Names:Prosed DS, Darpaz, more...Urelle, Uretron D/S, Uribel, Urimar-T, Urogesic Blue, Uticap, Utrona-C
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

methenamine/hyoscyamine

tablet

  • 81mg/0.12mg

tablet, capsule

  • 120mg/0.12mg
more...

Urinary Tract Infection Prophylaxis

1 tablet/capsule PO q6hr with liberal fluid intake

Use only after eradication of UTI by other appropriate antibiotic

Methenamine: Indicated for prophylaxis/suppression for chronic recurring UTIs when long-term therapy is required

Hyoscyamine: Adjunctive treatment for lower urinary tract hypermotility and spasm

Dosage Forms & Strengths

tablet

  • 81 mg/0.12mg

tablet, capsule

  • 120 mg/0.12mg
more...

Urinary Tract Infection Prophylaxis

<16 years: Safety/efficacy not established

≥16 years: 1 tablet/capsule PO q6hr with liberal fluid intake

Use only after eradication of UTI by other appropriate antibiotic

Methenamine: Indicated for prophylaxis/suppression for chronic recurring UTIs when long-term therapy is required

Hyoscyamine: Adjunctive treatment for lower urinary tract hypermotility and spasm

Avoid hyoscyamine except in short-term situations to decrease secretions; high incidence of anticholinergic effects (Beers criteria)

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Interactions

Interaction Checker

and methenamine/hyoscyamine

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Hyoscyamine

            • Dry skin

            1-10%

            Methenamine

            • Dysuria
            • Discoloration of urine (blue)
            • Gastric upset
            • Nausea
            • Rash

            Hyoscyamine

            • Blurred vision
            • Constipation
            • Dysphagia
            • Photosensitivity

            <1%

            Hyoscyamine

            • Headache
            • Orthostatic hypotension
            • Tachycardia
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            Warnings

            Contraindications

            Methenamine

            • Hypersensitivity to methenamine or tartrazine (FD&C Yellow No. 5)
            • Renal or severe hepatic insufficiency
            • Concurrent sulfonamides or acetazolamide may form insoluble precipitate in urine

            Hyoscyamine

            • Hypersensitivity to hyoscyamine or related compounds
            • Closed-angle glaucoma, myasthenia gravis, hemorrhage w/ cardiovascular instability, paralytic ileus, intestinal atony of elderly/debilitated pt, obstructive uropathy, toxic megacolon, GI obstruction, tachycardia secondary to cardiac insufficiency or thyrotoxicosis
            • Breastfeeding

            Cautions

            Methenamine

            • Large doses may cause bladder irritation, urinary frequency, albuminuria, and hematuria
            • Maintain acidic pH of urine, esp. when treating urea-splitting organisms (eg, Proteus, Pseudomonas)
            • Monitor LFTs, especially with history of liver impairment
            • Safe use not established during pregnancy, especially 1st and 2nd trimester
            • May precipitate uric acid stones in patients with gout

            Hyoscyamine

            • Renal/hepatic impairment, BPH, CHF, CAD, HTN, COPD, hiatal hernia, reflux esophagitis, mitral stenosis, brain damage or spastic paralysis in children, salivary secretion disorder, Down syndrome, autonomic neuropathy, hyperthyroidism, tachyarrythmia, toxin-mediated diarrhea
            • Elderly
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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: hyoscyamine and methenamine excreted in human milk; caution in breastfeeding women

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Methenamine: Hydrolyzed in acidic urine to ammonia and formaldehyde, which are bactericidal agents; does not convert to formaldehyde in serum

            Hyoscyamine: Elicits anticholinergic activity; decreases urinary spasms with cystitis

            Additional ingredients in some products: Methylene blue (weak antiseptic properties); sodium phosphate monobasic (acidifier); phenyl salicylate (mild analgesic)

            Absorption

            Well absorbed; 10-30% hydrolyzed by gastric acid unless enteric coated tablet

            Peak Urine Time: (formaldehyde) 2 hr for hippurate salt, 3-8 hr for mandelate salt

            Metabolism

            Liver (10-25%)

            Elimination

            Half-Life: 3-6 hr

            Excretion: urine (90%)  

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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