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WMJ : Official Publication of the State... Sep 2023Trimethoprim-sulfamethoxazole (TMP-SMX) and phenazopyridine are individually associated with methemoglobinemia through a series of altered reduction-oxidation reactions....
A Case That Will Take Your Breath Away: Acquired Methemoglobinemia Related to Trimethoprim-Sulfamethoxazole and Phenazopyridine Ingestion for Treatment of Urinary Tract Infection.
Trimethoprim-sulfamethoxazole (TMP-SMX) and phenazopyridine are individually associated with methemoglobinemia through a series of altered reduction-oxidation reactions. We report a case of methemoglobinemia associated with concurrent use of TMP/SMX and phenazopyridine in a 70-year-old woman with recurrent urinary tract infections. She presented to the emergency department for worsening back pain in the setting of recurrent urinary tract infections, concerning for pyelonephritis. During her workup, she became acutely hypoxic. The emergency department provider suspected the presence of abnormal hemoglobin. An arterial blood gas showing elevated levels of methemoglobinemia confirmed the suspicion. The combined use of TMP/SMX and phenazopyridine was thought to be the likely etiology of hypoxia. This case highlights the importance of medication management in the geriatric population, as well as the judicious use of antibiotics for urinary tract infections-a common chief complaint in the primary care setting.
Topics: Aged; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Phenazopyridine; Methemoglobinemia; Urinary Tract Infections; Eating
PubMed: 37768772
DOI: No ID Found -
Urology Aug 2019Phenazopyridine is a common, well-tolerated medication with minimal side effects. Severe side effects are rare and include methemoglobinemia in setting of overdose,...
Phenazopyridine is a common, well-tolerated medication with minimal side effects. Severe side effects are rare and include methemoglobinemia in setting of overdose, elderly patients, renal insufficiency, and chronic use. Here, we report a case of methemoglobinemia-induced perioperative hypoxia in an adolescent patient without renal insufficiency or overdose which has not been reported previously. This case underscores the importance of judicious use of this medication in all patients but notably in pediatric patients and those with chronic lung disease.
Topics: Adolescent; Humans; Hypoxia; Male; Methemoglobinemia; Phenazopyridine; Postoperative Complications
PubMed: 30917912
DOI: 10.1016/j.urology.2019.03.017 -
Neurourology and Urodynamics Nov 2010The clinical indication of phenazopyridine is unclear, it has been used clinically in conditions with increased bladder sensation as in cystitis and bladder pain... (Comparative Study)
Comparative Study
AIMS
The clinical indication of phenazopyridine is unclear, it has been used clinically in conditions with increased bladder sensation as in cystitis and bladder pain syndrome/interstitial cystitis. We explored the effect of phenazopyridine on afferent nerve activity by direct measurement of both Aδ- and C-fibers in the rat, and compared the outcome with the effects of lidocaine (a local anesthetic) and of acetaminophen (an analgesic).
METHODS
Female Sprague-Dawley rats were used. Under urethane anesthesia, single nerve fibers primarily originating from the bladder were identified in the L6 dorsal root by electrical stimulation of the left pelvic nerve and by bladder distention. By conduction velocity (2.5 m/sec) the fibers were defined as Aδ-fiber or C-fiber. The afferent activity in response to constant bladder filling was measured before the drug administration. Then, phenazopyridine (0.1-3 mg/kg) or lidocaine (0.3-3 mg/kg) or acetaminophen (1-10 mg/kg) was administrated intravenously. After drug administration, the afferent activity of bladder fillings was measured again.
RESULTS
All drugs significantly increased bladder compliance, in a dose-dependent way. Twenty-eight single afferent fibers (Aδ-fibers: n = 13, C-fibers: n = 15) were isolated. Intravenous administration of phenazopyridine significantly decreased dose-dependently only the Aδ-fiber but not the C-fiber activity. Also acetaminophen significantly decreased only Aδ-fiber activity, but it was not dose-dependently completely. Lidocaine inhibited both the Aδ- and C-fiber activities.
CONCLUSIONS
This study shows that phenazopyridine can directly inhibit the mechanosensitive Aδ-fibers in the normal rat bladder. This finding might explain its clinical effect in conditions of bladder hypersensitivity.
Topics: Acetaminophen; Analgesics, Non-Narcotic; Anesthetics, Local; Animals; Dose-Response Relationship, Drug; Electric Stimulation; Female; Lidocaine; Mechanotransduction, Cellular; Nerve Fibers, Myelinated; Nerve Fibers, Unmyelinated; Neurons, Afferent; Phenazopyridine; Rats; Rats, Sprague-Dawley; Urinary Bladder; Urodynamics
PubMed: 20976818
DOI: 10.1002/nau.20886 -
Journal of Medical Genetics Aug 1983A 25-year-old woman taking usual doses of phenazopyridine developed her third clinically significant episode of cyanosis. Life threatening methaemoglobinaemia was...
A 25-year-old woman taking usual doses of phenazopyridine developed her third clinically significant episode of cyanosis. Life threatening methaemoglobinaemia was documented and was treated with methylene blue. The patient and several members of her family showed decreased activities of erythrocyte NADH-cytochrome b5 reductase, predisposing them to the development of clinically significant methaemoglobinaemia when challenged with oxidant drugs.
Topics: Adult; Aminopyridines; Cytochrome Reductases; Female; Humans; Methemoglobinemia; NADH Dehydrogenase; Pedigree; Phenazopyridine
PubMed: 6620333
DOI: 10.1136/jmg.20.4.307 -
JAMA Dec 1978
Topics: Acute Disease; Acute Kidney Injury; Adolescent; Aminopyridines; Diagnosis, Differential; Female; Hepatitis; Humans; Kidney Tubules, Distal; Phenazopyridine; Suicide, Attempted
PubMed: 712988
DOI: No ID Found -
Journal of Community Hospital Internal... 2023Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive genetic disorder which commonly affects males. It is due to a defect in the red blood cell...
Syncope Following Treatment of UTI: A Case of Acute Hemolytic Anemia, Methemoglobinemia and Acute Renal Dysfunction Following Phenazopyridine Use in a Patient With G6PD Deficiency.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive genetic disorder which commonly affects males. It is due to a defect in the red blood cell enzyme, G6PD. Lack of G6PD makes the RBCs vulnerable to oxidant stress resulting in hemolysis. The severity of hemolytic anemia varies among individuals with G6PD deficiency. Here we present a case of an 80-year-old man admitted with syncope and jaundice. He was treated with phenazopyridine for a UTI 2 weeks ago. Subsequent investigation revealed G6PD deficiency as well as methemoglobinemia. Historically, phenazopyridine has been associated with causing methemoglobinemia and triggering hemolysis in G6PD deficient individuals. However, only a few cases have been reported in the last 60 years, making it a very rare occurrence.
PubMed: 36817304
DOI: 10.55729/2000-9666.1144 -
Biopharmaceutics & Drug Disposition Mar 1993
Topics: Animals; Benzoflavones; Detergents; Enzyme Induction; In Vitro Techniques; Indomethacin; Liver; Male; Metyrapone; Octoxynol; Phenazopyridine; Polyethylene Glycols; Proadifen; Rats; Rats, Wistar
PubMed: 8453026
DOI: 10.1002/bdd.2510140208 -
Environmental Science and Pollution... Mar 2023Water pollution by antibiotics is a global crisis, and its risk is critically more severe due to the explosive use of these drug compounds. A critical effective removal...
Water pollution by antibiotics is a global crisis, and its risk is critically more severe due to the explosive use of these drug compounds. A critical effective removal method to diminish this risk is heterogeneous photocatalysis and optimizing the conditions to reach higher mineralization efficiency. CeO anoparticles (NPs) were synthesized and characterized by X-ray diffraction (XRD), UV-Vis diffuse reflection spectroscopy (DRS), and Fourier transform infrared spectroscopy (FTIR) techniques. A cubic structural crystallite phase was detected that had crystallite sizes of 17.9 and 16.7 nm estimated by the Scherrer and Williamson-Hall models. A typical FTIR absorption band for the Ce-O stretching absorption has appeared at 554 cm. Based on DRS data and the Kubelka-Munk and Tauc models, Eg values of 2.80, 3.06, 3.12, and 3.13 eV were obtained for n-values of 1/2, 2, 3/2, and 3, respectively. pHpzc of CeO NPs was about 5.7. The direct photolysis and surface adsorption processes have no critical role in phenazopyridine (PP) removal by appearing with 2.7 and 6.7% removal efficiencies, respectively. Due to the highest photocatalytic activity of CeO NPs toward PP, the effects of the critical operating variable on the activity were evaluated, and the optimal conditions were as catalyst dose, 0.7 g/L; pH, 6; irradiation time, 90 min; and C, 20 ppm. The Hinshelwood kinetics equation plot was y = - 6.6442 - 0.4677x (r = 0.9296), in which its slope as the rate constant of the photodegradation process was 0.4677 min (corresponding to a t value of 1.48 min).
Topics: Phenazopyridine; Anti-Bacterial Agents; Cerium
PubMed: 36434455
DOI: 10.1007/s11356-022-24260-6 -
Annals of Internal Medicine Dec 1997
Topics: Aged; Aged, 80 and over; Humans; Male; Nails; Phenazopyridine
PubMed: 9412335
DOI: 10.7326/0003-4819-127-12-199712150-00040 -
Annals of Internal Medicine Jan 1987
Topics: Aminopyridines; Humans; Male; Meningitis; Meningitis, Aseptic; Middle Aged; Phenazopyridine
PubMed: 3789573
DOI: 10.7326/0003-4819-106-1-172_2