Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate, and Benzoic Acid

Derived from alkaloids which occur naturally in a variety of plants, Atropine, Hyoscamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid help to induce paralysis, increase heart rates and inhibit the effects of certain poisons.

Overview:

Atropine, Hyoscamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid are all medicines which are derived from plants, including Belladonna (often referred to as Deadly Nightshade) and Mandrake, amongst others. Although they can be deadly when used incorrectly, recreationally or administered as poisons, they do have a variety of clinical uses – particularly when combined together as one medicine, in pill form.

Atropine can be used to treat the effects of certain nerve agents, or to counteract pesticide poisonings. In some instances, it is used to decrease saliva production and/or the heart rate during surgery.

As an agonist of the muscarinic acetylcholine receptors, Hyoscyamine stops the action of acetylcholine in the saliva glands, sweat glands, central nervous system and stomach. At comparable doses, it operates at much the same rate as atropine. It is often used to provide symptomatic relief to spasms, IBS, colic, and cystitis. It has also been prescribed by doctors to control the symptoms of Parkinson’s disease, and studies suggest that it may be useful for pain control in combination with opioids.

Methenamine is primarily used to treat UTIs. Although its use was reduced by practitioners due to concerns that it could cause cystitis during overdose, it is now re-approved on account of many infections becoming resistant to antibiotics.

Methylene Blue can be used to treat urinary tract infection as part of a combination pill, and is also effective in the treatment of cyanide poisoning, ifosfamide toxicity and vasoplegic syndrome. When combined with light therapy it can be used to treat plaque psoriasis.

Phenyl Salicylate has antiseptic properties and acts as a mild painkiller. It has previously been used as an ingredient in sunscreens. Like Phenyl Salicylate, Benzoic Acid has been used since the early 20th century as an antiseptic, analgesic and expectorant.

When combined in pill form, these five medications are marketed as Prosed EC, Trac Tabs and Urised, and used to treat the symptoms of a variety of infections. However, despite reducing the level of discomfort associated with urinary tract infection, this combination therapy will not cure the infection itself. This combination may also be used for a variety of other conditions, some off-label, as directed by a doctor.

Conditions treated:

  • Urinary tract infection
  • Gastrointestinal disorders
  • Parkinson’s disease
  • Heart disease

Type of medicine:

  • Urinary antispasmodic

Side effects:

Along with the desired effects, a combination treatment of Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid can potentially cause some unwanted side effects. The most common side effects associated with this combination include: blurred vision, skin rash, pain in the eyes, dry mouth, difficulty urinating, vomiting and/or nausea.

During a course of treatment with this medicine, stools can potentially turn to a blue or blue-green hue in color. This is to be expected while taking the medicine, and can be experienced up to two weeks after finishing a course of tablets. Although it may seem alarming at first, it is par for the course and nothing to worry about.

As the patient continues to take this combination of medicines in pill form as prescribed, the previously mentioned symptoms should decrease. In the event of symptoms persisting over a prolonged period or getting worse, the patient is advised to contact their doctor immediately. Some of the minor symptoms, such as a dry mouth, can be alleviated by chewing sugar-free gum, or drinking regular glasses of cold water.

Like many medicines, there are potentially harmful, albeit rare, side effects some patients experience when taking a combination treatment of Atropine, Hyoscamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid. Symptoms of overdose include blood in the urine or stools, redness or flushing in the face, a fast heartbeat, severe drowsiness, pain or burning sensation when urinating, sweating, shortness of breath and/or unusual weakness or tiredness. In the event of one or more of these side effects occurring at uncomfortable levels, patients are advised to contact a healthcare professional as soon as possible or emergency services immediately if they feel the issue could be serious enough to warrant it.

Because this medication can potentially cause blurred vision, patients are advised to refrain from driving or operating heavy machinery when initially taking the drug. After taking a short course of the drug, a doctor may advise the patient that they are safe to drive on the basis that they aren’t currently experiencing blurred vision which could affect the safety of the patient and/or other road users.

Dosage:

As with all other medicines, it is important to only take a combination treatment of Atropine, Hyoscamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid as prescribed by a qualified physician. This means that patients should not take any more of the drug than they are advised to; nor should they take the drug at more regular frequencies than they have been advised to.

It is imperative that the patient pays close attention to any instructions the doctor may give at the time he or she prescribes this combination medicine. Instructions on the side of the package the tablets are supplied in should also be adhered to, provided they are similar – although the manufacturer will provide general dose instructions, it must be reiterated that these are merely recommendations which can be altered on a patient-by-patient basis by a doctor.

When determining the size of the dosage, a doctor will take into account the strength of the medicine, the physiology of the patient and a whole host of other factors. The reason why the medicine has been prescribed can also be a determining factor in dosage size, particularly with combination medications like this one.

Atropine, Hyoscamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid can be taken with or without food. It is recommended that patients take the tablet with a glass of water. Tablets should be swallowed whole, and not crushed, chewed or diluted.

Most marketable combinations of this medicine contain the following amounts of each drug:

  • Atropine/Hyoscyamine: 0.06mg
  • Methenamine: 81.6mg
  • Methylene Blue: 10.8mg
  • Phenyl Salicylate: 36.2mg

For the treatment of urinary tract infection in adults or children, one tablet is typically taken orally four times per day. The course of medication can last until the infection has subsided, and is often prescribed in conjunction with antibiotics or antifungal treatments to eliminate the infection at source, while the combination of Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid functions to treat the symptoms of discomfort and pain associated with said infection.

Patients are advised against taking double doses. In the event of the patient missing a dose, they should consider how long they have missed the dose by and how long it is until the next dose was due to be administered. If it is closer to the time for the next dose, the patient should omit the missed dose and then continue to take the medicine as planned.

If the patient should experience any serious signs of overdose (fast heartbeat, difficulty breathing, seizures or loss of consciousness) they are advised to contact the emergency services on 911 or the poison control center on 1800-222-1222 as soon as possible.

Interactions

All medicines have the potential to interact with other drugs or chemicals within the human body. When this happens, the effects of one or more medications can be altered, meaning a medicine is ineffective in treating the condition it was prescribed for. In other instances, an interaction can cause potentially dangerous side effects in a patient. Because of the potential for this to happen, patients are advised to keep a detailed list of each medicine they are currently taking, including the frequency and dosage. This extends to over the counter treatments, herbal supplements and vitamin pills or compounds, as well as prescription medicines.

Below is a list of some of the drugs known to have interacted majorly with one or more of the ingredients in a combined Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid tablet. Patients who are currently taking one or more of any of these medicines should notify their doctor before they take their first dose:

  • Acetazolamide
  • Ambenonium
  • Amitriptyline
  • Amoxapine
  • Amphetamine
  • Bupropion
  • Carbidopa
  • Carbinoxamine
  • Carbamazepine
  • Citalopram
  • Desipramine
  • Desvenlafaxine
  • Doxepin
  • Hydroxytryptophan
  • Doxylamine
  • Levodopa
  • Fluoxetine
  • Imipramine
  • Levomilnacipran
  • Linezolid
  • Lisdexamfetamine
  • Isocarboxazid
  • Mafenide
  • Maprotiline
  • Milnacipran
  • Mirtazapine
  • Nortriptyline
  • Opicapone
  • Paroxetine
  • Phenelzine
  • Phentermine
  • Potassium
  • Protriptyline
  • Pseudoephedrine
  • Rizatriptan
  • Safinamide
  • Selegiline
  • Sertraline
  • Silver Sulfadiazine
  • Sulfabenzamide
  • Sulfacetamide
  • Sulfapyridine
  • Sulfacytine
  • Sulfamethoxazole
  • Sulfasalazine
  • Sulfanilamide
  • Sulfathiazole
  • Sulfisoxazole
  • Sumatriptan
  • Tranylcypromine
  • Trazodone
  • Trimipramine
  • Tryptophan
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Zolmitriptan
  • Zonisamide

The use of a combined Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid tablet at the same time as any of the medicines mentioned above is not recommended, although your doctor may advise you that it is safe to combine them at reduced doses. In some instances, your doctor may decide not to treat you with a combination Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid tablet if you are taking a drug which interacts with it. In other cases, you doctor may adjust your current medication so that you can take Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid safely.

Patients who are prescribed Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid are recommended to avoid the use of alcohol altogether if possible. Caution should be taken when imbibing alcohol during the use of this medicine as alcohol can increase dizziness and drowsiness. In the event of combining Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid with alcohol, patients are advised to avoid any activities which require mental alertness.

Patients who are currently undergoing treatment for high blood pressure (hypertension) are advised that the use of urinary antispasmodics and anticholinergics could potentially exacerbate the condition. Therapy with Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid should therefore be administered cautiously in patients currently suffering from high blood pressure.

Warnings:

Before deciding to use Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid, the benefits of taking this combination of drugs should be weighed against the potential risks. The decision to undergo treatment with this medication should be made by the patient in conjunction with the doctor.

Patients are advised to tell their healthcare professional if they have ever had any allergic or unusual reactions to this medicine or any of the ingredients in the past. In addition to this, the patient should also discuss their medical history, including any current health problems.

Certain side effects caused by this medication are more likely to occur in children. These include nervousness, restlessness, warmth, irritability, dryness, flushing of the skin and unusual excitement. This is because children are generally more sensitive to Atropine and Hyoscyamine, which are both contained in this combination medication. Care should be taken when administering any drug containing these substances to children during hot weather or sub-tropical climates, as a rapid and potentially harmful increase in body temperature could occur.

Geriatric patients are more susceptible to the following side effects: constipation, difficulty urinating, agitation, confusion, memory loss, drowsiness or dry mouth. Like children, older patients are also more sensitive to the effects of Atropine and Hyoscyamine, and as such they may be more likely to experience the side effects more commonly seen in younger people. Older patients who have untreated glaucoma could also potentially experience eye pain when using Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid.

Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid is classed as a Pregnancy Category C drug by the FDA. This is because there are currently no adequate studies which have taken place in either pregnant women or animals in relation to this combination of medicines.

With regards to breastfeeding women using this medicine, Benzoic Acid is thought to pose a minimal risk to infants. The rest of the ingredients (Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate) have not been sufficiently studied, although doctors and healthcare professionals recommend postponing breastfeeding while undergoing treatment with this medicine, as some or all of the ingredients are known to be poisonous at large levels and the potential, albeit small, for these ingredients to pass into breast milk exists.

Patients who currently suffer from severe bleeding problems are advised to avoid Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid. This is because this combination of medicines could potentially increase the heart rate, therefore making bleeding problems worse.

Patients with brain damage are also advised to avoid taking this combination of medicines, as the CNS (central nervous system) effects of this drug could potentially be increased.

When using Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid, it is important that the urine of the patient is acidic. In order to achieve this, a doctor may prescribe a diet featuring protein, cranberry juice, prunes and plums. Patients are advised to avoid foods that turn the urine more alkaline, such as citrus fruits, milk and other dairy products. In conjunction with these dietary requirements, the patient should also aim to consume a full 8oz glass of water with each dose.

Storage:

Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid tablets should be stored at room temperature only. Freezing temperatures and excess heat should be avoided, as should moisture and direct light. It is therefore unsuitable for storage in a bathroom cabinet, for example. Ideally, this combination medicine should be kept in a cupboard or dedicated medicine cabinet, where it cannot be reached by children.

In the event of a doctor determining that the use of Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid is no longer necessary, the patient should dispose of the remaining supply safely and hygienically. Pharmacists can advise patients on how best to dispose of unused medication, and in some instances local pharmacies will offer a disposal or takeback scheme.

Summary:

While Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid is greatly beneficial in the treatment of urinary tract infections (amongst other conditions), its use can potentially pose a risk to any patients who fail to communicate effectively with their physician.

Because many infections are now resistant to antibiotics, many practitioners choose to use Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid to treat infections instead. Patients are advised that in many instances, the use of this medication will alleviate the symptoms of certain infections, but will not actually rid the body of the infection. To achieve this, a doctor may prescribe a dose of an antibiotic or anti-fungal medication either in conjunction with Atropine, Hyoscyamine, Methenamine, Methylene Blue, Phenyl Salicylate and Benzoic Acid or shortly afterwards.

In order to get the most out of this medication, the patient and doctor need to work together to decide upon the most appropriate dosage level.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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