methenamine / sodium phosphate / methylene blue / hyoscyamine
Urogesic Blue is a combination of 4 medications used to help ease urinary tract discomfort from conditions such as lower urinary tract infections (UTIs) or medical procedures. Methenamine, sodium phosphate, and methylene blue work to reduce bacteria in the urine, while hyoscyamine is an antispasmodic used to relieve bladder spasms. Urogesic Blue is usually taken by mouth 4 times a day in adults and children. This medication can make your urine blue as a side effect, but this is harmless and will go away. ME/NaPhos/MB/Hyo 1 is a generic alternative to Urogesic Blue.
What is Urogesic Blue?
What is Urogesic Blue used for?
Pain, discomfort, difficulty emptying the bladder, or other symptoms of irritative voiding (irritation while urinating)
Muscle spasms of the bladder from conditions such as lower urinary tract infections (UTIs)
Pain and discomfort of the urinary tract during some medical procedures
How Urogesic Blue works
Urogesic Blue is a combination of 4 medications:
Methenamine is broken down to formaldehyde in acidic urine, which stops the growth of bacteria.
Monobasic sodium phosphate is a type of salt that makes the urine acidic to help methenamine break down into formaldehyde.
Methylene blue is a mild antiseptic that kills or stops the growth of bacteria in the urine and bladder.
Hyoscyamine is an antispasmodic. It relaxes the smooth muscles in the bladder to help relieve muscle spasms and the urge to urinate.
Drug Facts
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What are the side effects of Urogesic Blue?
Common Side Effects
- Dry mouth
- Nausea
- Vomiting
- Blue urine or discolored stool
Other Side Effects
- Drowsiness
- Redness of your skin (flushing)
- Difficult urination
- Cannot empty your bladder fully
Serious Side Effects
- Serious allergic reactions: itching, rash, severe dizziness, swelling, or trouble breathing
- Symptoms of too much medication: fast heart rate, dizziness, blurry vision
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Blue or blue-green urine or stools
- Blurry vision
- Dizziness
- Dry mouth
- Nausea
- Upset stomach
Pros and cons of Urogesic Blue
Pros
Taken by mouth
Treats various urinary symptoms
Combines four medications into one tablet for convenience
Cons
Typically taken 4 times a day
Might not work as well if taking antacids at same time
Can cause bothersome side effects, such as dry mouth and nausea
Pharmacist tips for Urogesic Blue
Take Urogesic Blue with plenty of water to clear the bacteria out of your urinary tract.
The methylene blue in Urogesic Blue can cause your urine to turn a blue or blue green color. This side effect isn't harmful and should go away about a day or so after you stop taking this medication.
Urogesic Blue works best in acidic environment. Avoid taking antacids, such as calcium carbonate, at the same time as Urogesic Blue. Doing so will make the urine less acidic and cause Urogesic Blue to not work as well. If you need to take an antacid, separate it from Urogesic Blue by at least an hour.
Let your healthcare team know you're taking Urogesic Blue, especially if they prescribe an antibiotic to treat your UTI. The formaldehyde produced from methenamine can interact with sulfa antibiotics used to treat UTI, such as trimethoprim/sulfamethoxazole (Bactrim), and cause crystals to form in the urine.
Hyoscyamine in Urogesic Blue can cause constipation as a side effect. It's best to avoid taking Urogesic Blue with opioid pain medications because doing so can worsen constipation.
Let your healthcare team know if you're taking a monoamine oxidase inhibitors (MAOIs), such as rasagiline (Azilect). Taking Urogesic Blue with an MAOI raises your risk for a serious side effect called serotonin syndrome.
Urogesic Blue can cause serious harm if you or your child take more than what your prescriber has directed. If you or your child have symptoms of fast heartbeat, dizziness, blurry vision, slowed breathing, or seizures, stop taking this medication and get medical help right away.
Frequently asked questions about Urogesic Blue
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What are the risks and warnings for Urogesic Blue?
Urogesic Blue can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Fast heart rate
Risk factors: Irregular heartbeat | Heart failure | Heart problems
Taking Urogesic Blue might make your heart problems worse since hyoscyamine can raise your heart rate. These problems are more common in people with heart problems, such as heart failure and irregular heartbeat. Please let your prescriber know if you have any history of heart problems or if you have signs and symptoms of fast heart rate, such as dizziness, shortness of breath, or chest palpitations.
Risk of serious side effects in older adults
Risk factor: Over 65 years of age
Urogesic Blue contains hyoscyamine, which is an anticholinergic medication. It can cause confusion, dry mouth, and constipation. The symptoms are typically worse for older adults. Some studies have also showed that anticholinergic medications are related to higher risk of dementia. If you're over the age of 65, please talk with your prescriber about the benefits and risks of taking Urogesic Blue.
Risk of serious blood problem
Risk factor: People with low levels of glucose-6-phosphodiesterase (G6PD)
Urogesic Blue contains methylene blue. In people with low levels of G6PD (a genetic condition), this medication can lead to the break down of red blood cells. If you have low G6PD, please talk with your prescriber before taking Urogesic Blue. Please seek medical attention right away if you notice symptoms such as gray or blue-colored skin, headache, fast heart beat, shortness of breath, dizziness and lack of energy.
Risk of higher serotonin levels
Risk factor: People who take medications that raise serotonin levels
Methylene blue can raise the levels of serotonin (a chemical in the body that boosts your mood) in your brain. If you take multiple medications that raise your serotonin levels, such as fluoxetine (Prozac) or selegiline (Zelapar), then you're more likely to build up serotonin in the brain. Too much serotonin can cause serotonin syndrome, a serious and life-threatening condition. Get medical attention right away if you have signs and symptoms, such as confusion, muscle twitching, excessive sweating, shaking, dizziness, or fever. If you take any medications for your mental health, please talk with your prescriber before taking Urogesic Blue.
Reaction to belladonna plants
Risk factors: Children
Urogesic Blue contains hyoscyamine, which is a medication made from belladonna plants and can be dangerous if you take too much. Infants and toddlers can be particularly sensitive to belladonna toxins. Don't give Urogesic Blue to any children younger than 6 years old. If you notice your child has dry mouth, confusion, and memory loss after taking this medication, talk with your child's pediatrician right away.
Also, avoid taking Urogesic Blue if you're allergic to medications made from belladonna plants, such as atropine (Isopto Atropine) and scopolamine (Transderm Scop). Watch out for signs and symptoms of allergic reactions, such as hives, shortness of breath, swelling of your face, lips, or throat. Please get medical attention right away if you have these signs and symptoms.
Blockage in the intestines or bladder
Urogesic Blue contains hyoscyamine, which relaxes the muscles in the intestines and bladder. If you have any condition that prevents food from passing through your intestines, or if you have trouble emptying your bladder, this medication can make these conditions worse. Before starting Urogesic Blue, please talk with your prescriber about benefits and risks of taking this medication. Get medical attention right away if you have severe belly pain, nausea or vomiting, trouble urinating or blood in the urine.
Urogesic Blue dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 81.6mg/40.8mg/10.8mg/0.12mg | 30 tablets | $27.21 | $0.91 |
Typical dosing for Urogesic Blue
Adults: The typical dose is 1 tablet by mouth 4 times daily with plenty of fluids.
Children older than 6 years old: The dose will depend on the child's individual needs. Ask your child’s pediatrician about dosing and directions.
Children younger than 6 years old: Not recommended. Talk to your child's pediatrician about safer options.
What are alternatives to Urogesic Blue?
Pain, discomfort, difficulty emptying the bladder, or other symptoms of irritative voiding (irritation while urinating)
Muscle spasms of the bladder from conditions such as lower urinary tract infections (UTIs)
Pain and discomfort of the urinary tract during some medical procedures
Symptoms of irritative urination such as frequency, urgency, painful urination, and loss of bladder control
Urinary symptoms related to urinary tract infections (UTIs)
Urinary symptoms caused by medical procedures
Symptoms of irritative urination such as frequency, urgency, painful urination, and loss of bladder control
Urinary symptoms related to urinary tract infections (UTIs)
Urinary symptoms caused by medical procedures
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References
Best studies we foundBerdai, M. A., et al. (2012). Atropa belladonna intoxication: A case report. The Pan African Medical Journal.
Coupland, C. A. C., et al. (2019). Anticholinergic drug exposure and the risk of dementia: A nested case-control study. Journal of the American Medical Association Internal Medicine.
Edwards Pharmaceuticals, Inc. (2023). Urogesic Blue- methenamine, sodium phosphate, monobasic, methylene blue, and hyoscyamine sulfate tablet, coated [package insert]. DailyMed.
Guralnick, M. L., et al. (2011). Assessment and management of irritative voiding symptoms. Medical Clinics of North America.
Method Pharmaceuticals. (2024). Me Naphos MB Hyo 1- urinary antiseptic antispasmodic tablet [package insert]. DailyMed.
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Treatments for bladder control problems (urinary incontinence).
Prakash, S., et al. (2017). Green urine: A cause for concern? Journal of Anaesthesiology, Clinical Pharmacology.
U.S. Food and Drug Administration. (2017). FDA Drug Safety Communication: Serious CNS reactions possible when methylene blue is given to patients taking certain psychiatric medications.
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