From the FDA Drug Label
The decline in renal function associated with advanced age should be kept in mind. The use of Phenazopyridine in the elderly should be cautious due to the potential for accumulation of the drug in the body, which may be caused by impaired renal excretion.
- Key consideration: The drug label advises to keep in mind the decline in renal function associated with advanced age.
- Clinical decision: Use with caution in the elderly, monitoring for signs of accumulation, such as a yellowish tinge of the skin or sclera 1.
From the Research
Pyridium (phenazopyridine) should be used with extreme caution in elderly patients due to increased risks of severe side effects, and its use should be limited to the shortest duration possible, ideally no more than 2 days, at a reduced dosage of 100-200 mg two to three times daily. Elderly patients often have decreased kidney function, which can lead to drug accumulation and increased toxicity, as reported in a case of acute renal failure due to phenazopyridine overdose 2. Common side effects include orange-red discoloration of urine (expected and harmless), but more concerning are potential headaches, dizziness, and gastrointestinal disturbances. Pyridium should only be used for short-term symptom relief of urinary pain, burning, and discomfort, not as treatment for the underlying urinary tract infection itself. Antibiotics must be prescribed concurrently if infection is present. Elderly patients should be monitored for signs of methemoglobinemia (bluish discoloration of skin, fatigue, shortness of breath) and kidney dysfunction, as phenazopyridine has been associated with acute interstitial nephritis and other renal complications 3. Adequate hydration is essential during treatment, and the medication should be discontinued if symptoms of liver or kidney problems develop. Pyridium may interfere with urinalysis results, so diagnostic tests should be completed before starting the medication.
When prescribing Pyridium to elderly patients, it is crucial to consider the principles of rational, conservative, and evidence-based pharmacotherapy, taking into account the specificities of the elderly, their biological and chronological framework, and potential drug-to-drug interactions 4. The Beers Criteria list and STOPP/START criteria should be consulted to avoid potentially inappropriate medications for the elderly. Given the potential for severe adverse effects, the most recent and highest quality study available should guide clinical decision-making, emphasizing caution and careful monitoring in the use of Pyridium in elderly patients.