From the Guidelines
No, Pyridium (phenazopyridine) is not a urinary antispasmodic. It is a urinary analgesic that works by providing local pain relief in the urinary tract. Pyridium acts directly on the urinary tract mucosa to reduce pain, burning, urgency, and discomfort associated with urinary tract infections, trauma, surgery, or other conditions that cause irritation to the urinary tract. Unlike urinary antispasmodics such as oxybutynin or tolterodine which relax the smooth muscle of the bladder to reduce spasms and urgency, Pyridium does not affect muscle tone or contractions. It simply provides symptomatic relief by numbing the urinary tract lining.
The provided evidence does not support the use of Pyridium as a urinary antispasmodic, and instead, highlights the use of anticholinergics such as oxybutynin, tolterodine, and propiverine in the treatment of detrusor overactivity and enuresis 1. Additionally, the evidence suggests that antispasmodics may be beneficial in the treatment of irritable bowel syndrome with constipation, but this is not relevant to the use of Pyridium in the urinary tract 1.
Pyridium is typically prescribed for short-term use (2-3 days) while waiting for antibiotics to take effect in urinary tract infections. It's essential to note that Pyridium turns urine orange or red, which is a normal effect but can stain clothing and contact lenses, and patients should be informed of this side effect. The most recent and highest quality evidence does not support the use of Pyridium as a urinary antispasmodic, and its use should be limited to providing symptomatic relief in the treatment of urinary tract infections and other conditions that cause irritation to the urinary tract.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Phenazopyridine HCl is excreted in the urine where it exerts a topical analgesic effect on the mucosa of the urinary tract. DESCRIPTION Phenazopyridine Hydrochloride is light or dark red to dark violet, odorless, slightly bitter, crystalline powder. It has a specific local analgesic effect in the urinary tract, promptly relieving burning and pain.
The FDA drug label does not answer the question.
From the Research
Definition and Use of Pyridium
- Pyridium, also known as phenazopyridine, is a urinary tract analgesic used to relieve pain and discomfort associated with urinary tract infections, trauma, or surgery 2, 3, 4.
- It is often prescribed to patients with uncomplicated lower urinary tract infections accompanied by pain 3.
Mechanism of Action and Effects
- Pyridium works as a local anesthetic on the urinary tract mucosa, providing symptomatic relief from pain, burning, and discomfort during urination 3.
- However, there is limited clinical evidence on its effectiveness and safety, with some studies highlighting its potential for adverse effects, including hemolytic anemia, methemoglobinemia, and acute renal failure 2, 4, 5.
Adverse Effects and Safety
- Pyridium has been associated with various adverse effects, including yellow skin discoloration, hemolytic anemia, methemoglobinemia, and acute renal failure, especially in patients with preexisting kidney disease 2, 4.
- A case report described an elderly patient who presented with simultaneous multiple adverse effects, including a previously undocumented myelosuppressive pancytopenia 4.
- Despite these risks, a multicenter study found that phenazopyridine was well-tolerated and effective in treating patients with acute uncomplicated cystitis, with no serious adverse events reported 3.
Clinical Evidence and Recommendations
- The clinical evidence on the effectiveness and safety of pyridium is scarce, and its use as a urinary tract analgesic has been questioned 5.
- A study recommended that pyridium be used in addition to etiological therapy for symptomatic relief in patients with acute uncomplicated cystitis 3.
- However, the potential risks and limitations of pyridium use should be carefully considered, and patients should be monitored for adverse effects 2, 4, 5.