Methemoglobinemia Associated With Pyridium® Administration

Crawford, Susan E.; Moon, Ae Eun; Panos, Theodore C.; Hooks, C. A.

doi:10.1001/jama.1951.03670010028007

Cited by 31 publications

(9 citation statements)

References 4 publications

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“…It was first reported in an infant in 1951. 7 Aniline, a phenazopyridine metabolite, is metabolized to 3 compounds that directly oxidize the iron moiety of hemoglobin to ferric iron from ferrous iron, forming methemoglobin. Methemoglobin is unable to transport oxygen, leading to impaired oxygenation and tissue hypoxia.…”

Section: Discussionmentioning

confidence: 99%

“…8, 9 The lower end of the dosing range is recommended for patients with methemoglobin levels less than 50%. 7 The dose can be repeated after 1 hour if the initial dose is inadequate to reduce methemoglobin levels or the patient remains symptomatic. 8-10 Theoretically, repeat doses may be required in phenazopyridine ingestions, especially in the setting of acute renal failure, because of prolonged excretion of the product and its toxic metabolites.…”

Section: Discussionmentioning

confidence: 99%

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Phenazopyridine-Induced Toxicity in an Elderly Patient Receiving a Prolonged Regimen of Therapeutic Doses

Ronald

Demissie

2013

Journal of Pharmacy Technology

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Phenazopyridine is commonly used for its local analgesic effects on the urinary tract. It is taken with antibiotics for a short time, typically 2 days, to treat dysuria associated with urinary tract infections. Adverse reactions associated with phenazopyridine are limited and include mild gastrointestinal symptoms, headache, and dizziness, but in rare cases, patients can develop severe and life-threatening adverse reactions such as acute renal failure, hemolytic anemia, hepatitis, and methemoglobinemia. 1 We report a case of an elderly patient who developed phenazopyridine-induced toxicity while taking an appropriate dose of phenazopyridine for an extended duration of time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Phenazopyridine-Induced Toxicity in an Elderly Patient Receiving a Prolonged Regimen of Therapeutic Doses

Ronald

Demissie

2013

Journal of Pharmacy Technology

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“…The most common side effect is mild gastrointestinal discomfort [2]. Methemoglobinemia, Heinz body hemolytic anemia, liver toxicity, skin pigmentation as well as acute renal failure are described with the use of Pyridium® [3][4][5][6][7][8][9][10][11][12][13]. It is primarily excreted by the kidneys; 90% of a single dose is cleared within 24 h. Approximately 40% of the excreted drug is unmetabolized phenazopyridine [16] while the remainder is composed of the potentially toxic metabolites p-aminophenol, N-acetyl-p-aminophenol, and aniline [15].…”

Section: Discussionmentioning

confidence: 99%

“…Acute renal failure (ARF) is a rare but reported side effect [3][4][5][6][7][8][9][10]. Methemoglobinemia, hemolytic anemia, and skin pigmentation accompanies the transient renal failure in some of the reported cases [11][12][13][14][15]. We report a case of acute renal failure due to suicidal Pyridium® overdose in a young female with no prior documented kidney disease despite being infected with human immunodeficiency virus (HIV).…”

Section: Introductionmentioning

confidence: 99%

Acute renal failure due to phenazopyridine (Pyridium®) overdose: case report and review of the literature

et al. 2006

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Phenazopyridine (Pyridium) is a commonly used urinary tract analgesic. It has been associated with yellow skin discoloration, hemolytic anemia, methemoglobinemia, and acute renal failure, especially in patients with preexisting kidney disease. We report a 17-year-old female with vertically transmitted human immunodeficiency virus (HIV) infection, presenting with acute renal failure and methemoglobinemia following a suicidal attempt with a single 1,200 mg ingestion of Pyridium. She had no prior evidence of HIV nephropathy. The patient had a progressive nonoliguric renal failure on the 3rd day following the ingestion. She was treated with N-acetylcysteine, intravenous carnitine, and alkalinization of the urine. Her kidney biopsy revealed acute tubular necrosis with no glomerular changes. After 7 days of conservative management, she was discharged home with normal kidney function. To our knowledge, this is the second smallest amount of Pyridium overdose resulting in acute renal failure with no previous history of kidney disease.

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“…Several cases of phenazopyridine-induced oxidative damage to erythrocytes, as reflected by methaemoglobin formation and a Heinz body haemolytic anaemia, have been reported. [7][8][9][10][11][12] Renal failure accompanied by necrosis and dilatation of distal tubules has also been described. [13][14][15] Furthermore, there is evidence that phenazopyridine is myotoxic.…”

Section: Introductionmentioning

confidence: 99%

2,3,6-triaminopyridine, a metabolite of the urinary tract analgesic phenazopyridine, causes muscle necrosis and renal damage in rats

Munday

Manns

1998

J. Appl. Toxicol.

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Some aromatic polyamines form very stable free radicals and readily undergo autoxidation with concomitant formation of ‘active oxygen’ species. These substances cause necrosis of striated muscle in rats, and it has been suggested that this is due to free radical formation and disruption of energy production through their oxidation via the cytochrome c/cytochrome oxidase system of mitochondria. 2,3,6‐Triaminopyridine, which is structurally related to the myotoxic amines and likewise undergoes autoxidation and disrupts mitochondrial metabolism, is a metabolite of the widely used urinary analgesic phenazopyridine. When administered to rats, triaminopyridine caused extensive necrosis of skeletal muscle and a lesser degree of damage to heart muscle. It also induced vacuolation and necrosis of distal tubules of the kidney, associated with tubular dilatation and cast formation. Both muscle damage and renal tubular necrosis have been reported following use or abuse of phenazopyridine, and it is likely that triaminopyridine is responsible for both of these effects. © 1998 John Wiley & Sons, Ltd.

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Methemoglobinemia Associated With Pyridium® Administration

Cited by 31 publications

References 4 publications

Phenazopyridine-Induced Toxicity in an Elderly Patient Receiving a Prolonged Regimen of Therapeutic Doses

Phenazopyridine-Induced Toxicity in an Elderly Patient Receiving a Prolonged Regimen of Therapeutic Doses

Acute renal failure due to phenazopyridine (Pyridium®) overdose: case report and review of the literature

2,3,6-triaminopyridine, a metabolite of the urinary tract analgesic phenazopyridine, causes muscle necrosis and renal damage in rats

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