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Created: Jan. 1995
Bev Laumann & Jill Osborne
Revised: May 2, 2000

You are here: IC Network > Patient Handbook > Treatments > Oral Medications

About Oral Medications

Some of the following oral medications are sold over-the-counter and others must be prescribed by a physician. As always, please remember that IC patients should make an extra effort to research these treatment alternatives, methods of action and the length of time required to see any results. Consultation with your personal care provider is essential.

Bladder Coating: ELMIRON (Sodium Pentosanpolysulfate):

In September of 1996, the IVAX Corporation received final approval from the FDA to immediately begin marketing ELMIRON®. This is the first oral drug developed and approved specifically for the treatment of IC and is now being distributed in the USA by Alza Pharmaceuticals. (DMSO is the only other FDA-approved drug for IC, but it is instilled directly into the bladder).

Over the years, ELMIRON® has been extensively discussed, studied and tested but much is still unknown about it. Dr. Lowell Parsons, a leading IC researcher who was instrumental in the development of ELMIRON®, believes it works by providing a protective coating to the bladder wall. He believes that some IC patients have a damaged or "leaky" bladder lining (epithelium). For those that do, the ELMIRON® coating appears to prevent urine, bacteria and other irritating substances from penetrating an otherwise "leaky" lining and causing inflammation in the muscle tissue.

ELMIRON® is a white crystalline powder and comes in the form of capsules. The effective dose for ELMIRON® is 300 mg per day, taken either two or three times a day. ELMIRON® may take 3-6 months to work, and 6-12 months to work well by slowly rebuilding the GAG layer of the bladder (8). It may take more time to rebuild years of damage. Many doctors advise patients to give ELMIRON® at least a six month trial. Since ELMIRON® is thought to keep the bladder coated, it must be taken for the rest of the patient's life, or until a cure for IC is found.

Baker Norton conducted a very large physician use study in multiple centers across the USA. This trial enrolled 2,810 patients over a ten year period. One of the most comprehensive industry studies on IC, this may also be the longest IC treatment study to date. The data reveals that ELMIRON® patients showed a significant improvement during their course of treatment. The trial demonstrated that 42% of patients who had been treated for up to six months, and 60-62% of those treated for 24 months, had reported total, great or moderate relief of bladder pain. Of patients treated for six months, 55% had experienced a reduction in nocturia and 44% had reductions in frequency. Among patients who had no response to DMSO, more than 50% experienced moderate or better improvement when treated with ELMIRON® (8).

One of the benefits which ELMIRON® therapy can deliver is the elimination of the risk of infection that often accompanies catheterization and anesthesia. Some people experience side effects such as gastrointestinal upset or some hair loss. In some cases, your doctor may want to monitor your liver function through periodic blood tests while you are taking ELMIRON.®

Web Reference: Elmiron - USA

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Tricyclic Antidepressants: ELAVIL & TOFRANIL

Elavil® (amitryptyline) is a tricyclic antidepressant that, in low doses, is effective at relieving chronic pain by interfering with nerve activity. It is commonly prescribed for several chronic pain conditions, including irritable bowel syndrome (IBS) and fibromyalgia, two conditions that many IC patients also have. Its strength as a long-term pain management strategy, an essential part of an IC tool kit, makes it helpful in treating IC. It also may inhibit bladder spasms.

Several studies have reported a positive response with amitriptyline (9,10). Hanno (11) reports that amitriptyline was quite effective for patients who had not responded to hydrodistention and DMSO. Amitriptyline has side effects which merit consideration prior to taking it, including dry mouth, drowsiness and, for some patients, cardiac arrhythmias (irregular heart rate) and tachycardia (rapid heart rate).

Other antidepressants, such as Tofranil® (imiprimine), Prozac® and a host of others, may be options for physicians to consider. Amitriptyline, however, remains the most extensively tested medication of this type for IC.

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Antihistamines: ATARAX & VISTARIL

Mast cells are one of the body's first lines of defense against substances and invading organisms. Skin, nasal passages, and the gastrointestinal tract are all inhabited by mast cells. When you have a cold or suffer from fever, mast cells react to pollen or a virus by producing histamine and other substances. This leads to pain, inflammation and swelling.

Biopsies of some interstitial cystitis bladders, particularly ulcerative IC, have been found to have unusual numbers of mast cells. There is also speculation that mast cells in IC bladders do not function normally. In any case, antihistamine treatment in IC is aimed at stopping the "histamine-mast cell-inflammation" cycle in the bladder.

Atarax® and Vistaril® (generic name: Hydroxyzine HCL or Pomoate) are believed to block the activation of mast cells (12). Hydroxyzine has been shown in scientific studies to be very effective for IC patients, particularly patients with a history of allergies. Often used in conjunction with Elmiron, Hydroxyzine is now one of the most important therapies for IC patients.

The most common complaint of patients taking these drugs is that they cause drowsiness, dry mouth or irritability. Some people find that their drowsiness decreases in a few days. Hydroxyzine pomoate may be better tolerated than hydroxyzine HCL in some patients.

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Doctors attribute much of the urgency and frequency associated with IC to spasms of the bladder muscle. The drugs listed above are often prescribed to calm the bladder spasms. Levsin and levsinex may also be used to treat irritable bowel syndrome, a condition which occasionally accompanies IC and involves spasms of the colon.

Common side effects of antispasmodics can be dry mouth and drowsiness. All of the antispasmodics listed above are similar in terms of how the main ingredient helps IC, but they differ in terms of added ingredients and preservatives used. Some people may find they respond differently to each of the various brands.

A blend of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate and benzoic acid, urised inhibits the growth of organisms in the bladder as well as reducing spasms that cause frequency, urgency and nighttime trips to the bathroom. Urised shouldn't be used when you are taking certain other antibiotics.

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Urinary Anaesthetics: PYRIDIUM & URISTAT

Pyridium (phenazopyridine hydrochloride) is a prescription pain reliever that works by being excreted into the urine and soothing the bladder lining. It is often prescribed for temporary pain relief after surgery, cystoscopy, or catheterization. It is not prescribed for long-term use to control IC symptoms because it can build up in the body and cause harmful side effects. Pyridium colors the urine a very noticeable orange, and care must be taken to prevent staining of undergarments. Patients who wear contact lenses should be aware that occasionally contacts have become stained also.

Uristat is a non-prescription version of pyridium marketed by Johnson & Johnson and available at drugstores. It, too, should not be taken as a long-term pain treatment strategy but may be helpful for occasional use. IC patients who have chronic bladder infections find it useful to have on hand for times when they have bladder discomfort but can't get in to see the doctor right away.

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Combination Oral Therapies

The beneficial effects of combination therapies are often additive. That is, some people find increased success with combinations such as hydroxyzine and sodium pentosanpolysulfate, that they don't find with each alone. One benefit of combining therapies is that a lower dose of each can sometimes be used, thus avoiding side effects produced by higher doses. Because drugs do have side effects, you should always consult a doctor before using any drug for an extended time, and keep your doctor informed about over-the-counter medications you may be taking.

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