Hippurate (Hiprex)

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© Springer Nature Switzerland AG 2020
B. Yang, S. Foley (eds.)Female Urinary Tract Infections in Clinical PracticeIn Clinical Practicehttps://doi.org/10.1007/978-3-030-27909-7_8

8. Methenamine Hippurate (Hiprex)

Bob Yang1   and Steve Foley1

Royal Berkshire Hospital, Reading, GB, UK



Bob Yang

  • Two active components—Methenamine salts which are hydrolysed to formaldehyde and hippuric acid which acidifies the urine

  • Cochrane review 2012 showed Hiprex is effect in preventing recurrent UTIs

  • Short term courses (1 week or less) also effective in decreasing number of symptomatic UTIs

  • Hiprex is ineffective in the background of neurogenic bladders or patients with urinary tract abnormalities

  • Hiprex is prescribed as 1 g twice a day for adult patients. If the patient has a catheter, this can be increased to three times a day.

8.1 Introduction and Mechanism of Action

Since as early as the 1970s, Methenamine hippurate (Hiprex) has been used in the prevention of recurrent urinary tract infections [1]. Hiprex works via two pathways [2].

  • The methenamine salts component of Hiprex is excreted in the kidneys, whereupon a process called hydrolysis occurs, forming formaldehyde, a compound with bacteria killing properties.

  • The Hippuric acid component of Hiprex are also excreted by the kidneys, causing urine to turn acidic, which can either kill or neuter the bacteria within it

  • The acidic urine also provides the optimal environment to promote and increase the hydrolysis of the methenamine salts.

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Mar 23, 2021 | Posted by in UROLOGY | Comments Off on Hippurate (Hiprex)

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