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| Pronunciation | meh-THEH-na-meen[1] |
| Trade names | Antihydral, Hiprex, Urex, Urotropin, others |
| Other names | Hexamethylenetetramine; HMTA; Hexamine; Hexamethylenamine; Hexamethyleneamine; Metenamine; Urometine; Hippramine; E-239; R-657; 1,3,5,7-Tetraazaadamantane |
| Routes of administration | Oral,[2][3][4]topical[5][6] |
| Drug class | Antiseptic;Antibacterial |
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| Pharmacokinetic data | |
| Bioavailability | High (≥70%)[7][8][2] |
| Protein binding | Unknown[3] |
| Metabolism | Hydrolysis inacidicurine[3] |
| Metabolites | •Formaldehyde[3][9] •Ammonia[3][9] •Formic acid[10][11] |
| Onset of action | ≤30 minutes[3][4] |
| Eliminationhalf-life | 2–6 hours[2][7][3] |
| Excretion | Urine: 70–90% unchanged within 24 hours[3] |
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| Chemical and physical data | |
| Formula | C6H12N4 |
| Molar mass | 140.190 g·mol−1 |
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Methenamine, also known ashexamine orhexamethylenetetramine and sold under the brand namesHiprex,Urex, andUrotropin among others, is aurinary tractantiseptic andantibacterialmedication which is used in theprevention of recurrenturinary tract infections (UTIs).[1][8] It is not anantibiotic, and unlike antibiotics, has no risk ofbacterial resistance.[9][12] Methenamine can reduce the risk of UTIs by 44 to 86% and has been found to be non-inferior to low-dose prophylactic antibiotics.[13][14][15] It is takenby mouth.[3][8] The drug is available both byprescription and at lower dosesover the counter.[2] Besides for UTI prevention, methenamine is also available in atopical form to treathyperhidrosis.[5][6]
Side effects of methenamine are generally minor and includeupset stomach,nausea, andheadache, among others.[3][16][7] Methenamine is aprodrug offormaldehyde inacidicurine.[3][8][9] Formaldehyde is a non-specific antiseptic andbactericide which works viadenaturation of bacterialproteins andnucleic acids.[2][3][8][9] Conversion of methenamine into formaldehyde only occurs in acidic environments and hence its actions showselectivity fortissues like thebladder andstomach.[8][17]Chemically, methenamine is a simplecyclizedhydrocarbon and is similar in structure toadamantane.[12][7][8]
Methenamine was discovered in 1859[7] and was first introduced for medical use as a urinary antiseptic in 1895.[18][19] It was formally approved for medical use in theUnited States in 1967.[20] Though it became a "forgotten drug" following the discovery of antibiotics in 1928, there has been a resurgence in interest in methenamine since 2010 owing to increasing rates of bacterial resistance with antibiotics.[2][8][7][14][21] Larger and higher-qualityclinical trials of methenamine for UTI prevention have started to be published in the 2020s and it may soon be recommended by moremedical guidelines.[2][14][16][22][15] Methenamine has been found to be morecost-effective than low-dose prophylactic antibiotics for preventing UTIs.[23]
Methenamine is used in the treatment andprevention of recurrenturinary tract infections (UTIs) requiring long-term therapy.[3][1][2] It is approved and used in both adults and children at least 6 years of age.[1][9] The drug can also be used in special populations including older adults, people undergoing genitourinarysurgical procedures, people with long-termcatheterization, andkidney transplant recipients.[2][9] It has not been studied inneonates orinfants.[8] Methenamine is employed as an alternative toantibiotics.[13][2] The drug is not used in the curative treatment of UTIs and should be started only after bacterial eradication by appropriate antimicrobial agents.[4] As it is anantiseptic and not an antibiotic, methenamine has no risk of promotingbacterial resistance.[9][8] Studies have administered continuous methenamine therapy usually for 12 months or less,[2] but in some studies for as long as 2 to 10 years.[9][7]
A 2012Cochrane review found that methenamine was effective in the prevention of UTIs.[13] Therelative risk ofsymptomatic UTI was 0.24 and ofbacteriuria was 0.56.[13] In the case of short-term treatment (≤1 week), the relative risk of symptomatic UTI was 0.14.[13] On the other hand, methenamine was not effective in reducing the risk of symptomatic UTI or bacteriuria in people with knownrenal tract abnormalities orneurogenic bladder.[13] Thequality of evidence was mixed and often poor.[13][12]
A subsequent largerandomized controlled trial (RCT), the "ALternatives To prophylactic Antibiotics for the treatment of Recurrent urinary tract infection in women" (ALTAR) trial, was conducted by theUnited KingdomNational Health Service (NHS).[12][24] This study, published in 2022, reported that methenamine (hippurate) was non-inferior to daily low-dose antibiotics for prevention of UTIs.[14][15] The antibiotics used in the study includednitrofurantoin,trimethoprim, andcephalexin.[14][15] There was a small and non-significant numerical advantage of antibiotics over methenamine in this trial (~0.5 fewer UTIs per year), but this difference was deemed of limited clinical consequence and was considered to be outweighed by the advantages of methenamine.[2][15] UTI-free rates over 12 months were 43% with methenamine and 54% with antibiotics.[15] Besides effectiveness in terms of UTI prevention, methenamine demonstrated lower rates of bacterial resistance relative to antibiotic therapy in this trial and in other studies.[2][14][15]
A 2024systematic review found that methenamine was non-inferior to antibiotic prophylaxis in the prevention of UTIs in two comparativeprospectiveclinical studies, including the ALTAR trial.[16] Other, older studies found that methenamine was inferior to antibiotics includingtrimethoprim/sulfamethoxazole, trimethoprim, and nitrofurantoin in preventing or suppressing current UTIs, but these studies were of lower quality.[8] Additional large and high-qualityclinical trials of methenamine for UTI prevention are needed as of 2024.[16] More studies are also needed in special populations like older adults.[9] Another large RCT of methenamine for UTI prevention, the internationalEuropean ImpresU trial in older women, which is comparing methenamine toplacebo instead of against antibiotics, is underway as of 2022.[2][25]
Methenamine is not widely recommended bymedical guidelines for UTI prevention as of 2022.[22] However, this is expected to change in the near future due to the publication of the ALTAR trial and other new high-quality clinical trials.[22]
In addition toprescription methenamine, a lower-dosecombination formulation of methenamine with thenonsteroidal anti-inflammatory drug (NSAID)sodium salicylate is availableover-the-counter under brand names likeCystex for treatment and prevention of UTI symptoms.[9][2] This formulation is much less-studied than prescription methenamine and little data are available to inform its use.[9][2]
Methenamine is provided mainly as methenamine hippurate (thehippuric acidsalt) or methenamine mandelate (themandelic acid salt).[3][26][9][27][8] The drug is taken twice daily in the case of methenamine hippurate and four times daily in the case of methenamine mandelate.[8][9][4] Methenamine hippurate is more popular and commonly used owing to its more convenient dosing schedule.[2][14] Methenamine is taken three times daily in the case of formulations in which low-dose methenaminefree base is combined with sodium salicylate.[9][28] The dosing schedule of methenamine is less convenient than once-daily low-dose prophylactic antibiotics.[15]
Methenamine is converted intoformaldehyde only in acidic environments like the urinarybladder and hence is not expected to be effective in the eradicative treatment ofpyelonephritis (kidney infection) orchronic bacterial prostatitis.[8][29] As a result, it is not recommended for such indications.[8] However, methenamine may help to prevent pyelonephritis and hospitalization by preventing UTIs that can lead to these complications.[2][13][30][31] In addition, in men with persistent or recurring chronic bacterial prostatitis, prophylactic methenamine may be useful as an alternative to low-dose prophylactic antibiotics in preventing prostatitis-derived UTIs and managing associated symptoms.[32] Prophylactic low-dose methenamine combined with anascorbic acid (vitamin C)supplement has been reported to be effective for this purpose based onclinical experience.[32] In any case, supporting data for this use are lacking as of 2020.[32]
Methenamine, in atopicalcream orgel stick formulation sold under brand names like Antihydral and Dehydral, is used in the treatment ofhyperhidrosis (excessive sweating) and has been reported to be clinically effective for this indication.[5][6][33][34][35] The skin is slightlyacidic and formaldehyde can be released from methenamine in this environment.[5][6][11][33][34]
Methenamine is provided in the form of 500 and 1,000 mgoraltablets.[3][1][8] It is available both alone and incombination with thenonsteroidal anti-inflammatory drug (NSAID)sodium salicylate.[3][28] Other combinations with other drugs, such asphenazopyridine, are also available.[28]
Methenamine is providedpharmaceutically alone as thehippuric acid (methenamine hippurate) andmandelic acid (methenamine mandelate)salts.[3][26][9][27][8] Thefree base and other salts, including anhydromethylencitrate andsulfosalicylate, have also been marketed in some countries.[26] Methenamine mandelate is provided as anenteric coated tablet and is taken four times daily, whereas methenamine hippurate is available only in non-coated tablet form and is taken twice daily.[8][14][9][4] Non-coated methenamine tablets can have a chemical taste described as sweet, sour, and/or metallic.[14][36][37]
Methenamine is available bothby prescription (by itself) andover the counter (in combinations).[2][38][28] Over-the-counter formulationsin combination with sodium salicylate (162.5 mg) contain a lower amount of methenamine of 162 mg methenamine free base per tablet compared to prescription formulations and are taken three times daily.[2][9][3][28]
Thesafety of methenamine in people withrenal impairment is unknown and it is considered to becontraindicated in this context.[2][9][4] Other contraindications include severeliver disease orhepatic impairment, knownhypersensitivity to methenamine or the drug formulation's components, severedehydration,hyperphosphatemia, and use ofsulfonamides.[2][8][4] Caution is also advised in people withgout.[8] Its safety duringpregnancy is unclear and it is known to enter theplacenta,amniotic fluid, andbreast milk.[8] As such, discontinuation of methenamine is recommended duringbreastfeeding.[8] Noteratogenic effects with methenamine in animals have been observed.[4] Although the preceding contraindications of methenamine have been specified, they are not well-defined and may not be absolute contraindications in all cases.[2]
Side effects of methenamine are minor and infrequent, reportedly occurring in fewer than 4% of individuals.[4][3][13][16][7][8][27] They includedyspepsia (upset stomach),abdominal pain,dysuria (painful or uncomfortable urination),nausea,vomiting,diarrhea,headache,rash, andpruritus (itching).[3][16][7][8] The drug is generally verywell-tolerated.[12] Rarely, reversiblyelevated liver enzymes, including ofalanine aminotransferase (ALT) andaspartate aminotransferase (AST), have been reported.[8][4] Normalization of liver enzymes has occurred with discontinuation or continuation of methenamine.[8][4]Hypersensitivity reactions have also rarely been reported.[8][4] It has been said that methenamine, overall, is verysafe.[8]
Formaldehyde is a knowncarcinogen, for instance being associated withnasopharyngeal cancer andleukemia.[14][17][39] This compound also occurs in small amounts as a contaminant inalcoholic beverages, and is chemically similar to the carcinogenicethanol (alcohol)metaboliteacetaldehyde.[39][40] Because of the formaldehyde exposure with methenamine, there have been concerns about methenamine's potential carcinogenicity and the possibility that it might increase the risk ofcancer, for instancebladder orstomach cancer.[14][17] No clinical studies have looked directly at the long-term effects of methenamine in this regard.[14] However, there are no publishedcase reports documenting incidence of cancer with methenamine as of 2023.[14] Moreover,animal studies have found no evidence of long-term carcinogenicity with oral methenamine.[14][11][17] On the other hand, the findings of animal studies of methenamine and carcinogenicity have also been questioned by some authors,[17] though this topic is controversial.[11]
Antibiotics are known to disrupt thegut,urinary tract, andvaginalmicrobiota.[14] This has been associated with increased risk of recurrent UTIs.[14] Methenamine has been limitedly studied in this regard, but was found in one small study to preserve urinary microbial diversity.[14] However, more studies are needed to assess the influence of methenamine on the host microbiome, both in the urinary tract and elsewhere in the body.[14]
Side effects of thetopical form of methenamine forhyperhidrosis includedry skin, among others.[5][41]
Doses of methenamine much higher than usual have been clinically studied and found to produce significanttoxicity.[7][8][4] More specifically, doses of 8 g per day (4–8-fold usual doses) for 3 to 4 weeks resulted inbladder irritation,painful and frequent urination,albuminuria (albumin in urine),crystalluria (crystals in urine), andhematuria (blood in urine).[7][8][4] Some of these side effects are thought to be due to high levels offormaldehyde in the bladder and consequent irritation.[7][8] Doses of methenamine of up to 10 to 20 g/day have also been studied and found to be tolerable without major toxicity.[7] When methenamine was first introduced in the late 1800s and early 1900s, doses of 15 to 30 g per day were commonly employed and doses of up to 60 to 180 g per day were tried in some cases.[42] Toxic effects of such high doses included urinary tract and bladder irritation, frequent urination,strangury, and hematuria.[42]Animal studies employing double the modern human dosage of methenamine for 6 to 12 months found no adverse effects.[7]
Concomitant use of methenamine andsulfonamides can result ininsoluble methenaminesaltsprecipitating inurine and hence is not recommended.[8][4] Urinaryalkalinizing agents, such asantacids,carbonic anhydrase inhibitors, and certainfoods, may diminish the effectiveness of methenamine by making the urine morealkaline and thereby preventing thehydrolysis of methenamine intoformaldehyde.[8] Conversely, urinaryacidifying agents, likeascorbic acid (vitamin C),sodium acid phosphate, andammonium chloride, may enhance the effectiveness of methenamine by making the urine moreacidic and thereby facilitating its hydrolysis into formaldehyde.[9][12][8] Formaldehyde has been foundin vitro to react withhydrochloric acid to form the highlycarcinogenic compoundbis(chloromethyl) ether and it may be conceivable that this might likewise occur in thestomach.[17][43]
Methenamine has non-specificantiseptic andantibacterial properties inacidic environments viahydrolysis intoformaldehyde.[2][3][9][44] Formaldehyde is analdehyde and is highlyreactive and therebybactericidal.[3][10] It acts bybinding to anddenaturingbacterialproteins andnucleic acids.[3][9][10] Methenamine is almost completely inactive as an antibacterial inalkaline environments, in which it is not degraded into formaldehyde.[3][9][44]
The drug's spectrum of antibacterial activity includes all urinary tractpathogens.[27][2] It is specifically effective against common UTI-causing bacteria includingStaphylococcus saprophyticus,Escherichia coli,Enterococcus faecalis, andEnterococcus faecium.[2][3][4] However,Klebsiella aerogenes (Enterobacter aerogenes) has been said to generally be resistant to methenamine, although the mechanism and rationale supporting this resistance have not been described.[2][4] In addition, certainurea-splitting bacteria, such asProteus andPseudomonas species, can make the urine more alkaline, thereby potentially inhibiting the antibacterial effects of methenamine.[2][3][8][4]Providencia andMorganella species are also urea-splitting and might likewise be resistant to methenamine, although this topic requires more research.[2]
Methenamine is provided medically as thehippuric acid ormandelic acidsalt, and the acid salt component plays a key role in helping to make the urine more acidic such that the activity of methenamine is optimized.[2][3][9][27]Ascorbic acid (vitamin C),sodium acid phosphate, orammonium chloride can also be supplemented to further acidify the urine.[9][12][8] However, it is unclear whether this actually improves treatment effectiveness or not.[27][9]
Methenamine is rapidlyabsorbed from thegastrointestinal tract withoral administration.[3][8] Its oralbioavailability is high (≥70%).[7][8][2]
The drug isdistributed widely throughout the body, including insaliva,bile,cerebrospinal fluid,synovial fluids, andpleural effusions.[2] In accordance with its presence in cerebrospinal fluid, methenamine is known to cross theblood–brain barrier and enter thecentral nervous system.[7][2] Thevolume of distribution andplasma protein binding of methenamine are unknown.[3]
In terms ofmetabolism, methenamine ishydrolyzed to formformaldehyde andammonium inacidicurine (pH < 6).[2][3][9] More specifically, a single molecule of methenamine decomposes into six equivalents of formaldehyde and four ammonia molecules.[45][11] The drug may be degraded 10 to 30% in the acidic environment of thestomach prior to absorption.[8][17] This can be avoided withenteric coatedtablets.[2][8] In terms of pH, there is minimal hydrolysis at a pH of 7.4, 6% at a pH of 6, and 20% at a pH of 5.[2] The hydrolysis of methenamine occurs slowly and gradually, with approximately 3 hours required for 90% decomposition into formaldehyde.[2] As breakdown of methenamine only occurs in acidic environments like the bladder and stomach, the activation of methenamine into formaldehyde in the body istissue-selective.[2][8][17] Following its formation, formaldehyde is rapidly metabolized intoformic acid (formate) in the body.[10][11]
The drug iseliminated mainly by thekidneys.[3] A single oral dose of methenamine isexcreted 70 to 90% in urine unchanged within 24 hours.[3] Theonset of action of the urinary antibacterial effects of methenamine is within 30 minutes.[3][4] A urinary formaldehyde concentration of 18 to 60 μg/mL can be achieved with a typical therapeutic dosage of methenamine and these concentrations of formaldehyde can inhibit almost all urinary pathogens.[8][2] Theelimination half-life of methenamine is 2 to 6 hours.[2][3][7]
Methenamine, also known as 1,3,5,7-tetraazaadamantane, is a simplecyclichydrocarbon with a cage-likestructure and is similar in structure toadamantane (tricyclo[3.3.1.13,7]decane).[2][12][7][8][36] It is specifically theanalogue of adamantane in which thecarbonatoms at the 1, 3, 4, and 7 positions have been replaced withnitrogen atoms.[36][46] The drug is a white or colorless and odorlesscrystallinecompound with a sweet, sour, and/or metallic taste.[36][37] It is ahydrophilic compound with a predictedlog P (XLogP3) of 0.3.[36] Methenamine is usually provided medically as thehippuric acid ormandelic acidsalt.[2] Methenamine is thecation and hippuric acid or mandelic acid is theanion.[2]
Methenamine was first discovered as achemical compound in 1859.[7][46] It was introduced for medical use as aurinaryantiseptic under the nameUrotropin in 1895.[18][19] The drug was described as rapidlysterilizing and thereby restoringputrid andpus-filled urine to a normal appearance and constitution.[19] Acombination of methenamine withsalicylic acid was also developed and introduced the same year.[19] Methenamine was only used as a urinary antiseptic in cases ofacidic urine, whereasboric acid was used to treat UTIs withalkaline urine.[47] The drug namemethenamine, a contraction of the chemical or scientific namehexamethylenetetramine, was formally introduced and designated by theUnited States Pharmacopeia (USP) by 1925 and replaced the prior name of the drug that was being used ofhexamethylenamine.[48][49] The alternative drug namehexamine was introduced in theBritish Pharmacopoeia (BP) by 1914 to be used instead of the commercial nameUrotropin.[50]
Interest in methenamine declined after the discovery of theantibioticpenicillin in 1928 and it has been described as a "forgotten drug".[7][8] However, there was a surge of interest in methenamine from the 1950s to the 1980s.[2] The drug was formally approved by theFood and Drug Administration (FDA) for medical use in the United States in 1967.[20] Thetopical form of methenamine for treatment of hyperhidrosis was introduced around 1965.[33]
Subsequently, there was another decline in interest in methenamine from 1980 until 2010.[2]However, there has been another resurgence in interest in methenamine for recurrent UTI prevention since 2010 owing to increasing rates ofbacterial resistance with antibiotics.[2][8][7][14][21] Larger and higher-qualityclinical trials of methenamine for UTI prevention, such as theUnited Kingdom ALTAR trial, have started to be published in the 2020s, and additional trials, such as the internationalEuropean ImpresU trial, are also underway as of 2024.[2][14][16][22][15][25]
Methenamine is thegeneric name of the drug and itsINNTooltip International Nonproprietary Name,USANTooltip United States Adopted Name, andUSPTooltip United States Pharmacopeia, whilehexamine is itsBANTooltip British Approved Name andJANTooltip Japanese Accepted Name.[46][51][26] Brand names of methenamine includeAminoform,Antihydral,Dehydral,Formamine,Formin,Hexamine,Hiprex,Hyophen,Mandelamine,Metenamine,Phosphasal,Urelle,Urex,Uribel,Urimar,Urin DS,Urogesic Blue,Urotropin, andUstell, among numerous others.[3][1][46][26][35]
Methenamine is approved and available in theUnited States.[8] Only methenamine hippurate, the twice-daily formulation, is available as aprescription drug in the United States.[52] Of 38 countries that were surveyed in one study, methenamine was available in seven of them.[8] In any case, methenamine was marketed as aprescription drug widely throughout the world in 2004.[26] Thetopical form of methenamine forhyperhidrosis has been marketed only in certain countries, includingAustria,Canada,Germany,Luxembourg, andSwitzerland.[5][35][53]
The costs of methenamine for long-term UTI prophylaxis can be significant.[2] However, a 2024 study found that methenamine was morecost-effective than low-dose prophylactic antibiotics for prevention of UTIs.[23]
Methenamine might be useful in the treatment ofHelicobacter pylori infections as it is activated in the acidic environment of thestomach.[7]
The drug can safely be usedintravenously and might be useful in the treatment ofcentral nervous systeminfections as well as certaincancers.[7]
[Translated: Methenamine Due to the acidic pH of sweat, methenamine can produce formaldehyde, which also leads to denaturation. The finished product Antihydral® contains methenamine. Methenamine can be very drying, so the frequency of application must be reduced or moisturizing external agents must be used. Contact allergies to formaldehyde are possible.]
Other chemical agents used in the past for hyperhidrosis are the aldehydes. Glutaraldehyde 10% in a buffered solution was found to be effective for plantar hyperhidrosis in a study of 25 patients by Juhlin and Hansson.[52] Unfortunately, it stains the skin and can cause allergic sensitization and as a result is only suitable for feet. Formaldehyde also effectively reduced axillary sweating but its use today is not recommended due to its high risk of inducing an allergic contact sensitivity.[53] Although methenamine[54] converts into formaldehyde on the skin, it can be effective and is reported to be less sensitizing.
Urotropin.—The favorable reports that have come to my notice regarding urotropin lead me to think that some additional facts concerning it may not be amiss, says J. A. Flexner, M.D., in the American Practitioner and News, of December 28, 1895. Urotropin is a derivative of formic aldehyde, [...] Formic aldehyde being too irritating to be taken internally, Ficolaier then determined to try its amine combination as a substitute. This substance, hexamethylenetetranin or urotropin, is non-poisonous even in considerable quantities, is unirritating, very soluble in water, and is as good a uric acid solvent as formic aldehyde itself. The name urotropin was given to it on account of the changes which its administration brought about in the urine. Alkaline and putrid urines, containing mucous in excess, pus and pus organisms, uric acid or amorphous urates, were rapidly restored to a normal appearance and an acid reaction. The urine was sterilized, and increased in quantity, and calculi and deposits were dissolved. [...]
The normal pH of human prostatic fluid is 6.5–6.7, and it increases in chronic prostatitis, ranging from 7.0 to 8.3.
Chronic oral antibiotic suppression for men with persistent or recurrent prostatic infections despite antibiotic treatment is frequently used in clinical practice, even though supporting data are presently lacking [2, 18]. This approach appears to be generally effective, so long as suppression can be maintained [17]. Suitable choices include nitrofurantoin, trimethoprim-sulfamethoxazole, methenamine, fluoroquinolones, cephalosporins, tetracyclines, or any agent previously effective for the isolated pathogen. [...] In our experience, many patients who previously struggled with symptomatic recurrences have been well controlled with chronic low-dose prophylaxis with methenamine combined with a vitamin C supplement. However, the long-term utility of prophylaxis with methenamine therapy is not well documented in the existing literature [60].
Methenamine (hexamethelenetetramine, hexamine, urotropin) is a colorless and odorless crystalline compound with a sweet metallic taste.
Topical treatments include boric acid, topical anticholinergics, 2% to 5% tannic acid solutions, resorcinol, potassium permanganate, formaldehyde,23 glutaraldehyde, and methenamine. All of these agents have limited effectiveness or are restricted due to side effects such as staining, contact sensitization, and irritation.
"METHENAMINE" To the Editor:—Can you tell me anything about a drug "Methenamine" and where I might get it. It was mentioned in an abstract in THE JOURNAL, June 5, p. 631. E. W. W., M.D., Pittsburgh. ANSWER.—Methenamine is the name now used in the new U. S. P. X, which became official, January 1, for the substance described in the old pharmacopeia as hexamethylenamine; it is a more convenient contraction of the scientific name hexamethylenetetramine. All manuscripts sent to THE JOURNAL are, of course, edited in accordance with the nomenclature of the latest edition of the Pharmacopeia.
METHENAMINA Methenamine Methenam.—Hexamethylenamina U.S.P. IX, Hexamethylenetetramine [...]
Several synthetic preparations are included for the first time, and as mentioned elsewhere their names have been modified. Thus:— [New name: Hexamina.Name of Patent Product of same composition: Urotropin.] [The constitutional name of Hexamine is Hexamethylene-tetramine.]
