Sections

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

Class Summary

Antihistamines inhibit binding to the H1 histamine receptor.

Hydroxyzine (Vistaril)

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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.

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

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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.

Class Summary

Urinary analgesics relieve pain locally.

Pentosan polysulfate sodium (Elmiron)

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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.

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)

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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.

Class Summary

Antimicrobials with antiseptic and astringent qualities may reduce morbidity.

Class Summary

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

Heparin

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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.

Questions

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Author

Eric S Rovner, MD Professor, Department of Urology, Medical University of South Carolina College of Medicine

Eric S Rovner, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Clinical Urologists, American College of Surgeons, American Urological Association, International Continence Society, International Society of Urology, Society of Pelvic Reconstructive Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Justin D Ellett, MD, PhD Partner, Lowcountry Urology Clinics

Justin D Ellett, MD, PhD is a member of the following medical societies: American Association of Clinical Urologists, American Urological Association

Disclosure: Nothing to disclose.

Colin Murrah Goudelocke, MD Assistant Professor, Department of Urology, Medical University of South Carolina College of Medicine

Colin Murrah Goudelocke, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Antares.

Acknowledgements

Matthew Eskridge, MD Physician, Alliance Urology Specialists, Greensboro, NC

Matthew Eskridge, MD is a member of the following medical societies: American Urological Association and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Colin Goudelocke, MD, Physician, Academic Urology, Chattanooga, TN

Disclosure: Nothing to disclose.

Ricardo Sanchez-Ortiz, MD Assistant Professor of Urologic Oncology, University of Puerto Rico School of Medicine; Adjunct Assistant Professor, Department of Urology, The University of Texas MD Anderson Cancer Center

Ricarco Sanchez-Ortiz, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Interstitial Cystitis Medication

Medication Summary

Antihistamines, 1st Generation