Urimar-T (methenamine/methylene blue/salicylate/sodium phos/hyoscyamin)

Methenamine is commercially available as methenamine hippurate and methenamine mandelate; dosage is expressed in terms of the salt.

Dosage of salicylate salts must be carefully adjusted according to individual requirements and response, using the lowest possible effective dosage.

Unless otherwise directed by a clinician, choline salicylate, magnesium salicylate, sodium salicylate should not be used for self-medication of pain for longer than 10 days in adults; choline salicylate and sodium salicylate should not be used for self-medication of pain for longer than 5 days in children. Pain of such intensity and duration may indicate a pathologic condition requiring medical evaluation and supervised treatment. These preparations should not be used in adults or children for self-medication of marked fever (greater than 39.5degreesC), fever persisting longer than 3 days, or recurrent fever, unless otherwise directed by a clinician, since such fevers may indicate serious illness requiring prompt evaluation and treatment by a physician. In addition, these preparations should not be used in adults or children for self-medication of sore throat for longer than 2 days, unless otherwise directed by a clinician.

To minimize the risk of overdosage, no more than 5 doses of any of these drugs should be administered to children for analgesia or antipyresis in any 24-hour period, unless otherwise directed by a clinician.

Methylene blue is administered by slow IV injection over a period of several minutes (e.g., 5-30 minutes); high local concentrations of the drug should be avoided. (See Cautions: Adverse Effects.) Methylene blue also has been given by IV infusion+. The manufacturer of the commercially available 5-mg/mL solution for IV use (Provayblue(R)) states that the drug may be diluted, if desired, in 50 mL of 5% dextrose injection to avoid local pain, particularly in pediatric patients. While methylene blue has been diluted in 0.9% sodium chloride injection, some manufacturers recommend against this because chloride reduces the solubility of methylene blue. Methylene blue IV solutions should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. The diluted solution of the drug should be used immediately after preparation.

Methylene blue has been administered orally+, but oral preparations are no longer commercially available in the US. It has been suggested that an oral solution can be prepared extemporaneously by diluting 5-10 mL of the commercially available 10-mg/mL solution for IV use in 100-200 mL of water.

When used as a diagnostic (visualizing) dye+, methylene blue has been administered by local instillation or injection+. In addition, methylene blue has been administered topically+ for photodynamic therapy+ (PDT). (See Cautions: Adverse Effects.)

Methylene blue should not be administered by subcutaneous, intrathecal, or intraspinal injection. (See Cautions: Precautions and Contraindications.)

Vital signs, electrocardiogram (ECG), and methemoglobin concentrations should be monitored during treatment with methylene blue and through resolution of methemoglobinemia.

Choline salicylate, magnesium salicylate, sodium salicylate, and combination preparations containing choline salicylate and magnesium salicylate are administered orally. The drugs should usually be given with food or a large quantity (240 mL) of water or milk to minimize gastric irritation. Although rarely necessary, sodium salicylate may also be administered by slow IV infusion. Trolamine salicylate is applied topically.

Hyoscyamine is administered orally. Hyoscyamine sulfate is usually administered orally or sublingually. Hyoscyamine sulfate also may be administered by IV, IM, or subcutaneous injection when oral or sublingual administration is not feasible or when rapid therapeutic effect is necessary. Hyoscyamine sulfate is commercially available as conventional (immediate-release) tablets, extended-release capsules and tablets, oral solutions (drops), elixirs, sublingual tablets, orally disintegrating tablets, and injection.

Immediate-release preparations of hyoscyamine sulfate (conventional, sublingual, or orally disintegrating tablets; oral solutions (drops); elixirs) generally are administered orally or sublingually 3-6 times daily.

Extended-release preparations of hyoscyamine sulfate should not be crushed or chewed. Symax(R) SR and Symax(R) DuoTab(R) tablets should be swallowed whole, while Levbid(R) tablets and certain generic preparations are scored and may be broken in order to titrate dosage. Extended-release preparations generally are administered every 12 hours, but preparations that are not scored may be administered every 8 hours if dosage adjustment is required. Patients should be advised that extended-release preparations may not completely disintegrate and fragments may be excreted in stools in some patients.

Sublingual tablets of hyoscyamine sulfate (i.e., Levsin(R)/SL, Symax(R) SL, generic preparations) may be administered sublingually or orally. Certain sublingual tablets (e.g., Levsin(R)/SL, certain generic preparations) also may be chewed. The manufacturers of Levsin(R)/SL and certain generic preparations state that oral administration of the sublingual tablets results in similar pharmacologic effects as sublingual administration, although the onset may not be as rapid.

Orally disintegrating tablets of hyoscyamine sulfate (i.e., NuLev(R), Symax(R) FasTab(R), generic preparations) are administered by placing a tablet on the tongue to dissolve and be swallowed with the saliva; orally disintegrating tablets may be administered with or without water. Individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine should be warned that each 0.125-mg NuLev(R), Symax(R) FasTab(R), or generic hyoscyamine sulfate (marketed by Ethex) orally disintegrating tablet contains aspartame (NutraSweet(R)), which is metabolized in the GI tract to provide about 1.7, 4.5, or 0.5 mg, respectively, of phenylalanine following oral administration.

Because antacids may decrease absorption of oral hyoscyamine sulfate when these drugs are administered simultaneously, most manufacturers recommend administration of hyoscyamine sulfate before meals and administration of antacids postprandially. One manufacturer recommends routine administration of hyoscyamine sulfate (Symax(R) formulations) 30-60 minutes before meals.

Hyoscyamine sulfate injection may be administered by IV, IM, or subcutaneous injection without prior dilution. Parenteral hyoscyamine sulfate solutions should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

No enhanced messaging available.

Reproduction studies in rats and rabbits using methenamine hippurate have not revealed evidence of harm to the fetus. A slight increase in the stillborn rate and slight impairment of weight gain and survival of live-born offspring was reported in a study in pregnant dogs using oral methenamine in dosages equivalent to the human dosage. There are no adequate and well-controlled studies to date using methenamine hippurate or methenamine mandelate in pregnant women, and the drugs should be used during pregnancy only when clearly needed.

Although safe use of methenamine or its salts during pregnancy has not been definitely established, the drugs have been used in pregnant women without adverse effects to the fetus. One manufacturer of methenamine hippurate states that safety during the last trimester is suggested, but not definitely proven.

The effects of methenamine during labor and delivery are unknown and there are no recognized uses for the drug during labor or delivery.

Some manufacturers have stated that methylene blue is contraindicated in women who are or may become pregnant. There is epidemiologic evidence that methylene blue is a teratogen and can cause fetal harm if administered during pregnancy, especially during the second and third trimesters. Use of methylene blue in amniocentesis has been associated with intestinal atresia (e.g., ileum and jejunum), ileal occlusion, and other adverse effects in neonates. Intra-amniotic injection of methylene blue to detect ruptured membranes should be avoided.

Use of methylene blue during pregnancy has resulted in hemolytic anemia, hyperbilirubinemia, methemoglobinemia, respiratory distress, skin staining, and phototoxicity in neonates. If methylene blue is administered to a pregnant woman at term, the neonate should be observed for such adverse effects and appropriate supportive care instituted if needed.

If methylene blue is used during pregnancy or if the patient becomes pregnant, the patient should be apprised of the potential fetal hazard.

Because methenamine is distributed into milk and because of the potential for serious adverse effects in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.

It is not known whether methylene blue is distributed into human milk. Because of the potential for serious adverse reactions in nursing infants to methylene blue, including genotoxicity, some manufacturers state that breast-feeding should be discontinued during and for up to 8 days following treatment with methylene blue.

No enhanced messaging available.