Piperazine/Hexamine/Khellin effervescent granules Piperazine (as Piperazine citrate) What Piperazine/Hexamine/Khellin effervescent granules are used for: Piperazine/Hexamine/Khellin effervescent granules are used in the prophylaxis and treatment of chronic or recurrent lower urinary tract infections and asymptomatic bacteriuria. Do not take Piperazine/Hexamine/Khellin effervescent granules : Hypersensitivity to the active substance or to any of the excipients. Epilepsy or severe renal impairment and should be given with care to patients with neurological disturbances. It should also be avoided or given with extreme caution in patients with hepatic impairment. During pregnancy and lactation. Severe dehydration, metabolic acidosis, or gout. Warnings and precautions : Use with caution in patients with severe malnutrition and anaemia. Possible side effects: • Nausea, vomiting, diarrhoea, abdominal pain, headache, skin rashes, and urticaria occasionally occur. • Severe neurotoxicity and EEG abnormalities have been reported with symptoms including somnolence, dizziness, nystagmus, muscular incoordination and weakness, ataxia, paraesthesia, myoclonic contractions, choreiform movements, tremor, convulsions, and loss of reflexes. • Transient visual disturbances such as blurred vision, paralytic strabismus and rarely, cataracts. • Clonic contractions have occurred but are only likely if neurological abnormalities or renal disease exist. Allergic reactions occasionally encountered include: • Skin reactions, arthralgia, fever, oedema and tachycardia. Urticaria, photodermatitis, erythema multiforme, purpura, eczematous skin reactions, lacrimation, rhinorrhoea and rarely, broncospasm Other medicines and Piperazine/Hexamine/Khellin effervescent granules: • Use of hexamine with sulfonamides may increase the risk of crystalluria • The use of drugs that alkalinise the urine, including some antacids, potassium citrate, and diuretics such as acetazolamide or the thiazides, should be avoided How to take Piperazine/Hexamine/Khellin effervescent granules • 1 tablespoonful dissolved in a half glass of water after meals three times daily. • Do not exceed the recommended dose of Coli-urinal. How to store Piperazine/Hexamine/Khellin effervescent granules Store at temperature not exceeding 30°C in a dry place and close tightly after use. A valid prescription should be available upon delivery