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Drug Interactions between hyoscyamine / methenamine / methylene blue / phenyl salicylate and potassium bicarbonate / sodium bicarbonate

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

methenamine sodium bicarbonate

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate and potassium bicarbonate / sodium bicarbonate

GENERALLY AVOID: Agents that can alkalinize the urine such as thiazide diuretics, carbonic anhydrase inhibitors, and antacids may decrease the antibacterial effectiveness of methenamine by inhibiting its conversion to formaldehyde. Methenamine is most effectively converted in an acidic milieu of pH less than 5.5.

MANAGEMENT: Concomitant use of methenamine-containing preparations with thiazide diuretics, carbonic anhydrase inhibitors, or large doses of antacids should be avoided if possible. Otherwise, frequent urine pH testing may be considered. Some methenamine products may be used with antacids if dosing times are separated by at least one hour. Consult the manufacturer's product labeling for specific recommendations.

References

  1. Musher D, Griffith D "Generation of formaldehyde from methenamine: effect of pH and concentration, and antibacterial effect." Antimicrob Agents Chemother 6 (1974): 708-11
  2. Kevorkian C, Merritt J, Ilstrup D "Methenamine mandelate with acidification: an effective urinary antiseptic in patients with neurogenic bladder." Mayo Clin Proc 59 (1984): 523
  3. "Product Information. Hiprex (methenamine)." Hoechst Marion Roussel PROD (2002):
  4. Sand TE, Jacobsen S "Effect of urine pH and flow on renal clearance of methotrexate." Eur J Clin Pharmacol 19 (1981): 453-6
  5. "Product Information. Hyophen (benzoic acid/hyoscy/methen/mblue/phenylsal)." BioComp Pharma (2016):
View all 5 references

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Moderate

sodium bicarbonate phenyl salicylate

Applies to: potassium bicarbonate / sodium bicarbonate and hyoscyamine / methenamine / methylene blue / phenyl salicylate

MONITOR: Agents that cause urinary alkalinization can reduce serum salicylate concentrations in patients receiving anti-inflammatory dosages of aspirin or other salicylates. The mechanism involves reduction in salicylate renal tubular reabsorption due to increased urinary pH, resulting in increased renal salicylate clearance especially above urine pH of 7. This interaction is sometimes exploited in the treatment of salicylate toxicity.

MANAGEMENT: Patients treated chronically with urinary alkalinizers and large doses of salicylates (i.e. 3 g/day or more) should be monitored for potentially diminished or inadequate analgesic and anti-inflammatory effects, and the salicylate dosage adjusted if necessary.

References

  1. Berg KJ "Acute acetylsalicylic acid poisoning: treatment with forced alkaline diuresis and diuretics." Eur J Clin Pharmacol 12 (1977): 111-6
  2. Prescott LF, Balali-Mood M, Critchley JA, Johnstone AF, Proudfoot AT "Diuresis or urinary alkalinisation for salicylate poisoning?" Br Med J (Clin Res Ed) 285 (1982): 1383-6
  3. Balali-Mood M, Prescott LF "Failure of alkaline diuresis to enhance diflunisal elimination." Br J Clin Pharmacol 10 (1980): 163-5
  4. Berg KJ "Acute effects of acetylsalicylic acid in patients with chronic renal insufficiency." Eur J Clin Pharmacol 11 (1977): 111-6
  5. Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
View all 5 references

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Drug and food interactions

Moderate

hyoscyamine food

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. Linnoila M "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol 6 (1973): 107-12

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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