Interstitial Cystitis Medication

Updated: Nov 02, 2017
  • Author: Eric S Rovner, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Medication

Medication Summary

The goal of pharmacologic therapy in interstitial cystitis is to relieve symptoms. Medication may be administered orally or intravesically. Urinary analgesics include pentosan polysulfate sodium. (One report suggests a beneficial role for oral cimetidine.) Other agents used with less success include the following:

  • L-arginine
  • Nalmefene
  • Anticholinergic agents (eg, oxybutynin, oxybutynin XL, tolterodine [Detrol and Detrol LA])
  • Hyoscyamine
  • Corticosteroids
  • Antispasmodics
  • Immunosuppressives
  • Anti-inflammatory medications
  • Calcium channel blockers
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Antihistamines, 1st Generation

Class Summary

Antihistamines inhibit binding to the H1 histamine receptor.

Hydroxyzine (Vistaril)

Hydroxyzine is an H1 histamine receptor blocker that may inhibit mast cell secretion and may suppress histamine activity in the subcortical region of the central nervous system (CNS). Adult dosing is 25-75mg/day orally. Hydroxyzine is a pregnancy category C drug.

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Antidepressants, TCAs

Class Summary

Tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. They have central effects on pain transmission. They block the active reuptake of norepinephrine and serotonin.

Amitriptyline

Amitriptyline is an oral tricyclic antidepressant that inhibits reuptake of serotonin and/or norepinephrine at the presynaptic neuronal membrane, which increases concentration in the CNS. It may have anticholinergic and sedative effects. Adult dosing is 25-75 mg orally at bedtime. Amitriptyline is a pregnancy category D drug.

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Analgesics, Urinary

Class Summary

Urinary analgesics relieve pain locally.

Pentosan polysulfate sodium (Elmiron)

Pentosan polysulfate sodium is a negatively charged, synthetic sulfated polysaccharide with an affinity for mucosal membranes. It repletes defects in the glycosaminoglycan layer. Adult dosing is 100mg orally 3 times daily. Pentosan polysulfate sodium is a pregnancy category B drug.

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Urologics, Other

Class Summary

Instillation therapy may use dimethyl sulfoxide (DMSO). It may also use cauterizing agents for the removal of granulation tissue and dermatologic agents for their cleansing and disinfection and for the removal of necrotic debris.

Dimethyl sulfoxide (Rimso-50)

Dimethyl sulfoxide (DMSO) provides anti-inflammatory action, membrane penetration, antifungal activity, cryoprotective effects for living cells and tissues, collagen dissolution action, mast cell stimulation, nerve blockade, diuresis, cholinesterase inhibition, vasodilation, and muscle relaxation. It may be combined with heparin, steroids, or bicarbonate. In adults, instill 50mL of aqueous 50% solution directly into the bladder by catheter or Asepto syringe and allow it to remain for 20 minutes. DMSO is a pregnancy category X drug.

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Antibacterials, Topical

Class Summary

Antimicrobials with antiseptic and astringent qualities may reduce morbidity.

Silver nitrate

Silver nitrate is used for its caustic, antiseptic, and astringent qualities. In adults, administer concentrations ranging from 1:5000 to 2% intravesically for 2-10 minutes. Silver nitrate is a pregnancy category C drug.

Oxychlorosene (Clorpactin WCS-90)

Sodium oxychlorosene exerts detergent action on bladder mucosa. It is reserved for patients in whom DMSO or silver nitrate instillations fail. In adults, administer 0.4% solution intravesically for 2-3 minutes at 60-80cm water pressure (4-6 treatments weekly). Sodium oxychlorosene is a pregnancy category C drug.

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Anticoagulants, Hematologic

Class Summary

Anticoagulants prevent recurrent or ongoing thromboembolic occlusion of the vertebrobasilar circulation.

Heparin

Polysaccharide glycosaminoglycans may exert a protective effect on the bladder. Heparin has been shown to reduce relapses in patients who respond to DMSO. It is an analogue to the polysaccharide glycosaminoglycan lining of the bladder. Adult dosing is 10,000U intravesically in 10mL sterile water monthly. Polysaccharide glycosaminoglycans are pregnancy category C drugs.

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