Methenamine/Phenyl Salicylate/Methylene Blue/Benzoic Acid/Hyoscyamine, Oral

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KEY POINTS

• This medicine is taken by mouth to treat symptoms caused by urinary tract infections or certain procedures. Take it exactly as directed.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• This medicine may cause life-threatening problems if you take this medicine with certain other medicines. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: urinary antiseptic

Generic and brand names: methenamine/phenyl salicylate/methylene blue/benzoic acid/hyoscyamine, oral; Hyophen; Prosed DS; Urophen MB

What is this medicine used for?

This medicine is taken by mouth to treat symptoms of the urinary tract caused by urinary tract infections or certain procedures. It is a combination of medicines that fight bacteria, relieve pain, and decrease spasms.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine or to formaldehyde or benzoic acid
• A blockage in the intestines, Crohn's disease, or ulcerative colitis
• Glaucoma
• Heart disease or irregular heartbeat
• Kidney disease
• Liver disease
• Myasthenia gravis
• Trouble urinating or an enlarged prostate gland
• Ulcers

Tell your healthcare provider if you take a sulfonamide medicine.

Also tell your healthcare provider if you take any medicine for depression or other mental health problems.

Females of childbearing age: Tell your healthcare provider if you are pregnant or if you plan to become pregnant while taking this medicine. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Check the label on the medicine for directions about your specific dose. Take this medicine in evenly spaced doses for the length of time prescribed, even if you feel better.

Check with your healthcare provider before using this medicine in children under age 6 years.

You may take this medicine with or without food. Taking it with meals may lessen the chance the drug will upset your stomach. Swallow the tablets whole. Do not break, crush, or chew them. Take each dose with a full glass of water. Do not miss doses.

Drink water or cranberry juice between doses. Follow your healthcare provider's instructions about diet while taking this medicine.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: dry mouth, large pupils, hot or dry skin, flushing, drowsiness, blurred vision, fast or irregular heartbeat, coma, painful urination, blood in urine, severe nausea or vomiting, stomach pain, bloody diarrhea, unusual weakness or dizziness, headache, ringing in the ears.

What should I watch out for?

You may need regular urine tests to check whether there is enough acid for the medicine to work. Avoid citrus fruits, fruit juices, milk, and dairy products, which can decrease the amount of acid in the urine. Use antacids only if your healthcare provider approves.

You may need to have blood tests regularly to see how this medicine affects you. Keep all appointments.

Contact your healthcare provider if your condition does not improve in a few days or if it gets worse.

This medicine may cause a life-threatening problem called serotonin syndrome if you take it with certain other medicines, such as antidepressants, migraine medicines, pain medicines, some cough medicines, and St. John’s wort. Make sure that your providers know ALL of the medicines that you take. Contact your healthcare provider right away if you have:

• Restlessness
• Loss of coordination
• Fast heart beat
• Rapid changes in blood pressure
• Increased body temperature
• Nausea
• Vomiting
• Diarrhea

If you have a rapid pulse, dizziness, or blurred vision, stop taking the medicine and contact your provider right away.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert. Do not drink alcohol or take other medicines unless your healthcare provider approves

This medicine may change your urine or bowel movements to a blue or blue-green color. This is not harmful.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Trouble breathing, painful urination or trouble urinating, blurred vision, dizziness, fast or irregular heartbeat; heavy sweating or shaking; severe nausea, vomiting, or diarrhea; confusion or memory problems; loss of coordination; restlessness; fever and chills; muscle twitching.

Other: Nausea, vomiting, dry mouth, constipation, flushing, drowsiness.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Acetazolamide (Diamox)
• Alzheimer’s disease medicines such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon)
• Antacids that contain sodium bicarbonate, aluminum, or magnesium, such as Alka Seltzer, Gaviscon, Maalox, and Mylanta
• Anticholinergic medicines such as atropine, benztropine (Cogentin), dicyclomine (Bentyl), hyoscyamine (HyoMax, Levbid, Levsin), methscopolamine (Pamine), propantheline, and trihexyphenidyl
• Antidepressants such as amitriptyline, citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), maprotiline, mirtazapine (Remeron), nefazodone, nortriptyline (Pamelor), protriptyline (Vivactil), sertraline (Zoloft), trazodone, trimipramine (Surmontil), venlafaxine (Effexor), and vilazodone (Viibryd)
• Aspirin and other salicylates
• Atomoxetine (Strattera)
• Bladder control medicines such as darifenacin (Enablex), oxybutynin (Oxytrol), solifenacin (VESIcare), tolterodine (Detrol), and trospium
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Buspirone
• Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
• Citrus fruits and juices, milk, and dairy products
• Dextromethorphan, an ingredient in many cough, cold, or allergy medicines such as Robitussin-DM
• Diarrhea medicines such as atropine/diphenoxylate (Lomotil), diphenoxylate, and loperamide (Imodium)
• Diuretics (water pills) such as chlorothiazide (Diuril), chlorthalidone, hydrochlorothiazide (Microzide), methyclothiazide (Enduron), and metolazone (Zaroxolyn)
• Doxepin (Silenor)
• Ketoconazole (Nizoral)
• Linezolid (Zyvox)
• Lithium (Lithobid)
• Lorcaserin (Belviq)
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines that contain phenylephrine (Neo-Synephrine, Sudafed PE), pseudoephedrine (Sudafed), ephedrine, or caffeine (such as cough, cold, or allergy medicines, pain medicines, stimulants, or diet pills)
• Medicines to treat breathing or lung problems such as aclidinium (Tudorza), albuterol (ProAir, Proventil, Ventolin), arformoterol (Brovana), fluticasone/salmeterol (Advair), formoterol (Perforomist), metaproterenol, mometasone/formoterol (Dulera), salmeterol (Serevent), and terbutaline
• Methazolamide (Neptazane)
• Methyldopa
• Midodrine
• Migraine medicines such as almotriptan (Axert), dihydroergotamine (D.H.E. 45, Migranal), eletriptan (Relpax), ergotamine (Ergomar), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, Sumavel), and zolmitriptan (Zomig)
• Milnacipran (Savella)
• Muscle relaxants such as baclofen (Gablofen, Lioresal), carisoprodol (Soma), cyclobenzaprine (Amrix), dantrolene (Dantrium), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Myasthenia gravis medicines such as edrophonium, neostigmine (Prostigmin), and pyridostigmine (Mestinon, Regonol)
• Natural remedies such as SAMe, St. John's wort, and tryptophan
• Pain medicines such as buprenorphine (Buprenex, Butrans), codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Roxicet), pentazocine (Talwin), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Parkinson’s disease medicines such as bromocriptine (Cycloset, Parlodel), entacapone (Comtan), levodopa/carbidopa (Duopa, Rytary, Sinemet), rasagiline (Azilect), and tolcapone (Tasmar)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Procarbazine (Matulane)
• Promethazine
• Stimulants such as amphetamine/dextroamphetamine (Adderall), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), methamphetamine (Desoxyn), and methylphenidate (Concerta, Daytrana, Metadate, Ritalin)
• Sulfa antibiotics such as sulfadiazine, sulfamethoxazole/trimethoprim (Bactrim, Septra), and sulfasalazine (Azulfidine)
• Typhoid vaccine

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.