Interstitial Cystitis

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Questions to Ask Your Doctor about Interstitial Cystitis
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Treatment

There is no cure for IC; the goal of treatment is to relieve symptoms. Often, treatment efficacy (effectiveness) wanes and a replacement must be found through trial and error. Most patients who suffer from IC find relief, usually with multiple, complementary treatments.

Medications
Medications used to treat IC are administered by different methods. They include:

• Systemic medication – drugs taken orally
• Local medication – medication instilled directly into the bladder via a catheter
• Chronic pain medications

Systemic Medication

Pentosan polysulfate sodium (Elmiron®) is the only oral medication approved by the Food and Drug Administration (FDA) for IC. It is thought to prevent irritating elements in the urine from affecting the cells that line the bladder, but its precise method of action is unknown. Since Elmiron is chemically similar to glycosaminoglycan (GAG), it is thought to help rebuild the epithelium by coating the bladder wall. It may take up to 6 months to provide relief from symptoms, although 25% of patients experience significant symptom relief in as few as 4 weeks. Elmiron must be taken on a long-term basis to keep symptoms from recurring. Side effects include gastrointestinal discomfort and reversible hair loss, but these are uncommon.

Hydroxyzine (Vistaril®, Atarax®) is an antihistamine and mild antianxiety drug. It prevents mast cell degranulation, which is thought to play a role in IC, particularly in patients who have a history of allergies, migraine, and irritable bowel syndrome. Hydroxyzine decreases nighttime urination (nocturia), frequency, pain, and bladder pressure. Side effects include dry mouth and sedation.

Oxybutynin chloride (Ditropan XL®) , Detrol®, and a combination of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid (Urised®) may reduce bladder spasms that cause frequency, urgency, and nighttime urination. Valium and other muscle relaxants may also be used to reduce spasms associated with IC. Amitriptyline (Elavil®) and doxepin (Sinequan®) are tricyclic antidepressants that help to block pain, calm bladder spasms, and reduce inflammation; they may be useful in small doses.

Local Medication

Dimethyl Sulfoxide (DMSO, Rimso-50®) may be instilled (intravesical) through the urethra and directly into the bladder via a catheter. It is the only FDA-approved instillation treatment for IC. It enters the bladder wall and reduces inflammation, pain, and painful muscle contractions; it may be mixed with heparin, steroids, or other local anesthetics. It may leave a garlicky taste and smell on the skin and in the breath for up to 72 hours. Heparin is similar to GAG and may help to repair problems caused by GAG deficiency in the bladder.

Blood, liver, and kidney tests are required every 6 months during DMSO therapy.

Hyaluronic acid (Cystistat®) and Bacille Calmette-Guerin (BCG) are undergoing clinical trials for IC treatment and are not widely available in the United States. Similar to heparin and GAG, Cystistat may help to repair a deficient bladder lining. BCG is a weakened form of cow tuberculosis (Mycobacterium bovis), which is used in tuberculosis vaccine in some European countries. Research shows that it may stimulate the immune system and improve the cellular makeup of the epithelium.

The risk factors of BCG treatment are not fully understood, but may include inflammatory response in the bladder, tuberculosis-like chest infection, and the development of fibrous lumps (granulomas) in the bladder. Silver nitrate and sodium oxychlorosene (Clorpactin®) were once used for instillation but needed to be administered under general anesthesia and are now considered outdated, because they cause irritation and greater risk for complications in the abdomen.

Temporary worsening of symptoms can occur up to 36 hours after any instillation treatment. Chemical cystitis is also a possible side effect.

Chronic Pain Medications

A typical IC treatment regimen includes medication for chronic pain:

• Anticonvulsant drugs – Tegretol®, Neurontin®
• Benzodiazepines–Xanax®, Ativan®
• Narcotics – Vicodin®, Percocet®
• Nonsteroidal anti-inflammatory drugs (NSAIDs) – Advil®, Aleve®, Celebrex®
• Trycyclic and SSRI antidepressants – Tofranil®, Prozac®

Generally, these are calming drugs. Benzodiazepines, for example, are used to treat anxiety; they are now thought to exert analgesic effects and reduce pelvic floor muscle spasm. Antidepressant medications affect levels of neurotransmitters in the brain, which are responsible for mood, concentration, and the ability to manage difficult situations. They, too, are used for their pain-blocking effects. IC sufferers typically have sensitivities to foods and drugs, which may be activated by these medications. It may be necessary to take them initially in small doses. Some may be combined, under the supervision of a physician, to control severe pain.

Many of these drugs carry a risk for kidney and liver dysfunction, and some require routine monitoring and blood tests. Pregnant women should consult their physicians before taking them. Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

Follow each drug section link for side effects and precautions.

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