Methenamine/sodium salicylate
{{Short description|Over-the-counter UTI drug}}
{{Infobox drug
| drug_name =
| type = combo
| image = Hexamine.svg
| width = 125px
| caption = Chemical structure of methenamine
| image2 = Sodium salicylate2DCSD.svg
| width2 = 150px
| caption2 = Chemical structure of sodium salicylate
| component1 = Methenamine
| class1 = Urinary antiseptic and antibacterial
| component2 = Sodium salicylate
| class2 = Nonsteroidal anti-inflammatory drug (NSAID) and analgesic
| pronounce =
| tradename = Cystex, others
| Drugs.com = {{drugs.com|mtm|methenamine-and-sodium-salicylate}}
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| routes_of_administration = Oral
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| ATC_prefix = G04
| ATC_suffix = BX17
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| legal_US = OTC
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| synonyms = Sodium salicylate/methenamine; Methenamine/salicylate; Methenamine/salicylic acid; Salicylate/methenamine; Salicylic acid/methenamine; Hexamine/sodium salicylate; Hexamine/salicylate
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Methenamine/sodium salicylate, sold under the brand name Cystex among others, is a combination drug comprising methenamine and sodium salicylate. Methenamine serves as a urinary antiseptic and antibacterial agent, while sodium salicylate is a nonsteroidal anti-inflammatory drug (NSAID) and analgesic. The combination is used for the treatment and prevention of urinary tract infection (UTI) symptoms.{{cite journal | vauthors = Li JM, Cosler LE, Harausz EP, Myers CE, Kufel WD | title = Methenamine for urinary tract infection prophylaxis: A systematic review | journal = Pharmacotherapy | volume = 44 | issue = 2 | pages = 197–206 | date = February 2024 | pmid = 37986168 | doi = 10.1002/phar.2895 }}{{cite journal | vauthors = Chwa A, Kavanagh K, Linnebur SA, Fixen DR | title = Evaluation of methenamine for urinary tract infection prevention in older adults: a review of the evidence | journal = Therapeutic Advances in Drug Safety | volume = 10 | issue = | pages = 2042098619876749 | date = 2019 | pmid = 31579504 | pmc = 6759703 | doi = 10.1177/2042098619876749 }}{{cite web | title=Methenamine: Uses, Interactions, Mechanism of Action | website=DrugBank Online | date=31 December 1993 | url=https://go.drugbank.com/drugs/DB06799 | access-date=11 October 2024}}{{cite web | title=Search Results for methenamine | website=DailyMed | date=2 February 2016 | url=https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=methenamine&searchdb=all&labeltype=all&sortby=rel&audience=professional&page=1&pagesize=100 | access-date=11 October 2024}}
Medical uses
Methenamine, whether used alone or in combination with sodium salicylate, is considered an alternative to antibiotics for the treatment and prevention of UTIs and related symptoms. Unlike antibiotics, methenamine does not contribute to the risk of bacterial resistance.{{cite journal | vauthors = Lo TS, Hammer KD, Zegarra M, Cho WC | title = Methenamine: a forgotten drug for preventing recurrent urinary tract infection in a multidrug resistance era | journal = Expert Review of Anti-Infective Therapy | volume = 12 | issue = 5 | pages = 549–554 | date = May 2014 | pmid = 24689705 | doi = 10.1586/14787210.2014.904202 }}
= Available forms =
The drug is available over-the-counter (OTC), including in the United States, and is typically taken by mouth three times per day.
Methenamine/sodium salicylate is marketed under several brand names, including Cystex Urinary Pain Relief, AZO Urinary Tract Defense, Uro-Pain Dual Action, and CVS Antibacterial Plus Urinary Pain Relief.{{cite web | title=Methenamine and sodium salicylate Uses, Side Effects & Warnings | website=Drugs.com | date=7 November 2023 | url=https://www.drugs.com/mtm/methenamine-and-sodium-salicylate.html | access-date=14 October 2024}} Some formulations also include phenazopyridine and are marketed as products like the All-In-One UTI Emergency Kit.
= Comparison with methenamine =
Methenamine is also available as a prescription drug and is used alone to prevent recurrent UTIs.{{cite journal | vauthors = Kale S, Somani BK | title = The resurgence of methenamine hippurate in the prevention of recurrent UTIs in women- a systematic review | journal = Current Opinion in Urology | volume = 33 | issue = 6 | pages = 488–496 | date = November 2023 | pmid = 37337660 | doi = 10.1097/MOU.0000000000001108 }}{{cite journal | vauthors = Lee BS, Bhuta T, Simpson JM, Craig JC | title = Methenamine hippurate for preventing urinary tract infections | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD003265 | date = October 2012 | pmid = 23076896 | pmc = 7144741 | doi = 10.1002/14651858.CD003265.pub3 }} Clinical evidence supports its efficacy for this indication.{{cite journal | vauthors = Davidson SM, Brown JN, Nance CB, Townsend ML | title = Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence | journal = International Urogynecology Journal | volume = 35 | issue = 3 | pages = 483–489 | date = March 2024 | pmid = 38329493 | doi = 10.1007/s00192-024-05726-2 }} Prescription methenamine is usually administered as the hippuric acid or mandelic acid salt, while the OTC methenamine/sodium salicylate formulation uses methenamine as the free base.{{cite book | author=Schweizerischer Apotheker-Verein | title=Index Nominum: International Drug Directory | publisher=Medpharm Scientific Publishers | year=2004 | isbn=978-3-88763-101-7 | url=https://books.google.com/books?id=EgeuA47Ocm4C&pg=PA775 | access-date=11 October 2024 | pages=775–776}}
Compared to prescription methenamine, the OTC combination formulation contains lower doses of methenamine. This OTC version has been studied less extensively, and limited clinical data are available to guide its use.
See also
References
{{Reflist}}
{{Antiseptics and disinfectants}}
{{Other antibacterials}}
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