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  • Urogesic Blue
    (hyoscyamine sulfate/methenamine/methylene blue/monobasic sodium phosphate)

    THERAPEUTIC CLASS

    Acidifier/antibacterial/anticholinergic/antiseptic

    DEA CLASS

    RX

    INDICATIONS

    Treatment of symptoms of irritative voiding. Relief of local symptoms (eg, hypermotility) that accompany lower UTIs, and as antispasmodic. Relief of urinary tract symptoms caused by diagnostic procedures.

    ADULT DOSAGE

    Urinary Tract Symptoms

    Relief of symptoms of irritative voiding, local symptoms (eg, hypermotility) that accompany lower UTIs and also used as an antispasmodic, and urinary tract symptoms caused by diagnostic procedures

    1 tab qid followed by liberal fluid intake

    PEDIATRIC DOSAGE

    Urinary Tract Symptoms

    Relief of symptoms of irritative voiding, local symptoms (eg, hypermotility) that accompany lower UTIs and also used as an antispasmodic, and urinary tract symptoms caused by diagnostic procedures

    >6 Years:
    Individualize dose

    ADMINISTRATION

    Oral route

    HOW SUPPLIED

    Tab: (Hyoscyamine/Methenamine/Methylene Blue/Monobasic Sodium Phosphate) 0.12mg/81.6mg/10.8mg/40.8mg* *scored

    CONTRAINDICATIONS

    Consider risk-benefit w/ the following: cardiac disease (especially cardiac arrhythmias, CHF, coronary heart disease, mitral stenosis), GI tract obstructive disease, glaucoma, myasthenia gravis. Acute urinary retention may be precipitated in obstructive uropathy (eg, bladder neck obstruction due to prostatic hypertrophy).

    WARNINGS/PRECAUTIONS

    Do not exceed recommended dosage. D/C immediately if rapid pulse, dizziness, or blurred vision occurs. Intolerance may occur in patients intolerant to belladonna alkaloids. Infants and young children are especially susceptible to toxic effects of belladona alkaloids. Caution in elderly; may respond to usual doses of hyoscyamine w/ excitement, agitation, drowsiness, or confusion.

    ADVERSE REACTIONS

    Rapid pulse, flushing, blurred vision, dizziness, SOB or troubled breathing, difficulty micturition, acute urinary retention, dry mouth, N/V.

    DRUG INTERACTIONS

    May decrease absorption of other oral medications (eg, urinary alkalizers, thiazide diuretics, antimyasthenics). Take at least 2 hrs after ketoconazole. May increase the risk of severe constipation w/ opioids. Sulfonamides may precipitate w/ formaldehyde in the urine, increasing the danger of crystalluria. Hyoscyamine: Concomitant use w/ antimyasthenics may further reduce intestinal motility. Concomitant use w/ MAOIs may intensify antimuscarinic side effects. Antimuscarinic effects may be intensified w/ antimuscarinics. Antacids/antidiarrheals may reduce absorption, decreasing effectiveness; space dosing 1 hr apart w/ antacids/antidiarrheals. Methenamine: Thiazide diuretics or antacids may reduce effectiveness.

    PREGNANCY AND LACTATION

    Category C, safety not known in nursing.

    MECHANISM OF ACTION

    Hyoscyamine: Parasympatholytic; relaxes smooth muscles and produces antispasmodic effect. Methenamine: Antibacterial; degrades in an acidic urine environment releasing formaldehyde, which provides bactericidal or bacteriostatic action. Methylene Blue: Antiseptic; possesses weak antiseptic properties. Monobasic Sodium Phosphate: Acidifier; helps to maintain an acid pH in the urine necessary for the degradation of methenamine.

    PHARMACOKINETICS

    Absorption: Hyoscyamine/Methenamine/Methylene Blue: Well absorbed. Distribution: Hyoscyamine: Plasma protein binding (moderate), Methenamine: Plasma protein binding (some formaldehyde bound to substances in urine and surrounding tissues). Methenamine/Hyoscyamine: Crosses placenta; found in breast milk. Metabolism: Hyoscyamine: Hepatic. Methenamine: Hydrolysis to formaldehyde. Methylene Blue: Reduced to leukomethylene blue. Elimination: Hyoscyamine: Urine (13-50% unchanged). Methenamine: Urine (70-90% unchanged). Methylene Blue: Urine (75% unchanged).

    ASSESSMENT

    Assess for cardiac disease, GI tract obstructive disease, glaucoma, myasthenia gravis, obstructive uropathy, intolerance to belladonna alkaloids, hypersensitivity to any of the ingredients, pregnancy/nursing status, and possible drug interactions.

    MONITORING

    Monitor for rapid pulse, dizziness, blurring of vision, and other adverse reactions.

    PATIENT COUNSELING

    Counsel about risks and benefits of therapy. Instruct to d/c and consult physician if rapid pulse, dizziness, or blurred vision occur. Advise not to exceed recommended dose. Advise to inform physician if taking other medications. Inform that urine may become blue to blue green and feces may be discolored.

    STORAGE

    25°C (77°F); excursions permitted to 15-30°C (59-86°F).