6 Common Questions About Phenazopyridine (AZO) Interactions Answered

Phenazopyridine (AZO Urinary Pain Relief) is a urinary analgesic that has been around for over 100 years. It helps provide short-term relief of urinary pain while the cause of the pain is being treated. Common causes of urinary pain include a urinary tract infection (UTI), surgery, and bacterial vaginosis (BV). Yeast infections and kidney stones can also cause urinary pain.

Before starting phenazopyridine, you may have questions about whether it’s safe to take with other pain relievers, antibiotics, and more. Below, we answer six common questions about phenazopyridine interactions.

1. Which medications interact with phenazopyridine (AZO)?

Many people can safely take phenazopyridine. But if you exceed the recommended dose, take it longer than recommended, are an older adult, or have kidney problems, there’s a risk of developing methemoglobinemia. This is a blood disorder where changes in your red blood cells impact their ability to carry oxygen. It’s rare with phenazopyridine, but possible.

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The risk of methemoglobinemia may be higher if you take phenazopyridine with other medications that have a similar effect. Examples of medications that have been reported to cause methemoglobinemia include:

• Dapsone (oral and topical)

• Lidocaine / prilocaine (EMLA) cream

• Chloroquine (Plaquenil)

• Metoclopramide (Reglan)

• Topical benzocaine products

• Sulfamethoxazole / trimethoprim (Bactrim)

You should only take phenazopyridine for up to 2 days, unless you’ve been instructed differently. With proper use, the risk of a significant interaction is likely low for most people. Be sure to follow the instructions and avoid taking more than the recommended amount. Contact your healthcare team right away if you develop symptoms such as fatigue, weakness, and a bluish discoloration of your skin or mucous membranes.

If you’re an older adult, have kidney problems, or frequently need urinary pain relief for recurrent UTIs, talk to your healthcare team before taking phenazopyridine. And if you take other medications, it helps to share your current medication list so they can check for potential interactions.

2. Can you take phenazopyridine with antibiotics for a UTI?

Yes, it’s OK to take phenazopyridine with antibiotics. In fact, it’s common to take both at the same time. This is because phenazopyridine provides pain relief as the antibiotic starts working. But as mentioned above, don’t take phenazopyridine for more than 2 days, unless you’re told otherwise. By then, the antibiotic should have started working and your pain should improve.

As noted above, Bactrim is on the list of medications linked to methemoglobinemia. It’s also a commonly prescribed antibiotic for UTIs. Taking phenazopyridine with Bactrim is likely OK for many people, as long as you stay within the recommended dosages. But it’s a good idea to check with your prescriber first, especially if you’re older or have kidney problems.

EXPERT PICKS: WHAT TO READ NEXT

• Phenazopyridine side effects: Learn more about potential phenazopyridine (AZO Urinary Pain Relief) side effects, from headaches to changes in urine color.

• Over-the-counter UTI treatment: Experts cover which over-the-counter products really work for urinary tract infection (UTI) symptoms.

• Best drinks for a UTI: Here are the best (and worst) things you can drink if you have a UTI.

Remember, phenazopyridine only provides temporary relief. It doesn’t treat your infection. So don’t put off getting treated, even if your symptoms get better.

3. Is it safe to take Tylenol with phenazopyridine?

Yes, it’s generally safe to take Tylenol (acetaminophen) with phenazopyridine. Tylenol can also be helpful for UTI pain. But like phenazopyridine, Tylenol does not treat the infection causing your UTI. So, it can’t take the place of antibiotics.

Tylenol is safe for most people. But it may not be right for you if you have liver problems or drink a lot of alcohol. 

Check with your pharmacist or prescriber before taking any OTC pain relievers, including Tylenol. While rare, there have been reports of methemoglobinemia with Tylenol. However, this seems to be linked to taking too much Tylenol. So, be sure to stay within the maximum daily dosage.

4. Is it OK to take phenazopyridine and ibuprofen together?

Yes, you can take phenazopyridine with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil). Like Tylenol, ibuprofen can help with painful urination and flank pain caused by a UTI. That will give you some relief until the antibiotic starts to take effect.

Most people can safely take ibuprofen at recommended dosages for a few days. But it’s not safe for everyone. And it has a number of side effects. Your risk for these side effects is higher if you have certain medical conditions, are older, or take medications that can interact with it.

Talk to your pharmacist or prescriber before taking ibuprofen. They can help determine if it’s OK for you to take the medication.

5. Can you drink alcohol while taking phenazopyridine?

There isn’t any known direct interaction between alcohol and phenazopyridine. But alcohol can irritate your bladder and cause more pain during urination. If you’re taking an antibiotic, it can also increase your risk for side effects.

It’s never recommended to mix antibiotics with alcohol. But you definitely shouldn’t drink while taking metronidazole (Flagyl) and for at least 3 days afterward. Metronidazole isn’t typically used for UTIs. But it’s commonly used for BV, which can also sometimes cause painful urination.

6. Can you take phenazopyridine with methenamine?

Methenamine (Hiprex) is an antibiotic. But unlike other antibiotics, it’s not used to treat an active UTI. It’s taken long term to prevent chronic, recurrent UTIs.

It’s OK to take phenazopyridine with methenamine. But if you have painful urination, you could have an active UTI. And methenamine does not treat an active UTI. In this case, contact your healthcare team to get appropriate treatment.

When should you contact your healthcare team about a phenazopyridine interaction?

Phenazopyridine has very few interactions. But if you’re an older adult or have kidney problems, check with your healthcare team before taking it. It’s also a good idea to share your current medication list for their review. Contact them right away if you experience symptoms such as fatigue, weakness, or bluish skin discoloration while taking it.

Phenazopyridine can help provide urinary pain relief. But you should still contact your healthcare team if you’re experiencing this symptom. Phenazopyridine is a pain reliever and will not treat the underlying cause. And keep in mind that you should only take it for up to 2 days, unless instructed otherwise.

Contact your healthcare team if you are taking antibiotics for an infection, such as a UTI or BV, and your symptoms don’t start improving within a few days. They may decide to try a different antibiotic.

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Written by:

Alex Evans, PharmD, MBA

Alex Evans, PharmD, MBA, has been a pharmacist for 12 years. His first job was floating in a community chain pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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