Medicines and urine discolouration
Most people who fall sick resort to the use of medicines; orthodox or herbal, to restore health to permit them to continue with their normal daily activities.
There are a variety of medicines used to restore health depending on the diagnosis made by the clinician and these medicines may on their own change the colour of urine as they are eliminated or affect physiological processes leading to release of some endogenous pigments which may colour the urine.
Urine colour and discolouration
The normal urine has appearances such as; colorless, pale yellow, yellow, deep amber and these shades of color are due to the concentration of the pigment urochrome and the presence of other pigments which can be from within the body (endogenous).
Examples of these pigments are hemoglobin, myoglobin (a protein found in skeletal muscle and the heart), bilirubin, melanin, uric acid crystals and homogentisic acid.
Exogenous sources of urine pigments are usually from medicines, foods, dyes, poisonous materials and snake venoms. Other factors like pH, the presence of infections and medical conditions may also change the colour of urine.
Patients sometimes report an observation of change in urine color and sometimes other body fluids like sweat, tears and saliva when on various medicines. It is probable that one would be alarmed upon seeing this change in body fluids colour and discontinue their medicines whilst their disease condition deteriorates resulting in fatal outcomes.
The discoloration is indeed not normal as it is a deviation from one’s normal physiological state. However most discolorations are benign and would resolve when the associated agent is removed.
The discoloration of body fluids by various medications is a side effect and is usually not desired. Let me quickly add that it is not all patients that experience the change in color (discoloration) of their body fluids, especially urine when on a medication known to be associated with such an effect.
Therefore, when one observes any discoloration of their urine it is appropriate to quickly contact your pharmacist or medical doctor for advice and further investigations to rule out possible disease conditions such as UTI, rhabdomyolysis, kidney stones, melanomas, malignancies, metabolic disorders, hepatic diseases among others.
Some disorders and their corresponding urine color produced:
- Red/orange could be due to haematuria or hemoglobinuria (blood in urine)
- Brown urine colour could be as a result of presence of myoglobin, hemoglobin or hemolysis from snake bite
- Cola-like urine could be as a result of hemolysis from malaria infection or presence of myoglobin or bile in urine due to liver or kidney diseases
- Yellow urine discoloration is common in jaundice due to hepatic disorders or malaria infection or other disorders that cause excessive breakdown of red blood cells
- Green urine discoloration is commonly associated with pseudomonas infection in urinary tract infection and
- Blue urine discoloration could be due familial indicanuria.
To add on, various foods and food pigments used as additives or a component of the food can cause urine discoloration.
Examples of medicines that cause discoloration of urine when administered.
| Medicine | Color of urine |
| Rifampicin | Orange/red |
| Phenazopyridine | Orange/red |
| Riboflavin | Orange |
| Sulfasalazine | Orange |
| Doxorubicin | Orange |
| Chlorpromazine | Red |
| Thioridazine | Red |
| Senna | Red |
| Laxatives with components of phenolphthalein | Red |
| Hydroxocobalamin | Red |
| Nitrofurantoin | Brown |
| Metronidazole | Brown |
| Chloroquine | Brown |
| Primaquine | Brown |
| Senna leaves laxatives | Black |
| Cascara bark laxatives | Black |
| Sorbitol | Black |
| L-dopa | Black |
| Alpha-methyldopa | Black |
| Methocarbamol | Black/blue/green depending on urine concentration |
| Promethazine | Green |
| Indomethacin | Green |
| Propofol | Green/blue |
| Amitriptyline | Green |
| Metoclopramide | Green |
| Cimetidine | Green |
| Methylene blue | Blue |
Medicines that discolor urine green can also sometimes discolor urine blue.
REFERENCES
Stalin Viswanathan, “Urine Bag as a Modern Day Matula”, International Scholarly Research Notices, vol. 2013, Article ID 215690, 8 pages, 2013. https://doi.org/10.5402/2013/215690
WRITTEN AND EDITED RESPECTIVELY BY:
MPSGH, MRPharmS, MPhil.
Isaiah Amoo is a practicing community pharmacist in good standing with the Pharmacy Council of Ghana who has meaningful experience in academia and industrial pharmacy. He is a member of the Royal Pharmaceutical Society, England, UK and currently pursuing his overseas pharmacy assessment programme (MSc) at Aston University, UK. He had his MPhil degree in Pharmaceutical Chemistry at Kwame Nkrumah University of Science and Technology. He has about 5 years’ experience as a community Pharmacist and has also taught in academic institutions like KNUST, Kumasi Technical University, Royal Ann College of Health, and G-Health Consult. He likes to spend time reading medical research articles and loves sharing his knowledge with others.
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