Oral Medication Options
A wide variety of prescription oral medications are available for use, each with their own potential risks and benefits.
Amitriptyline (aka Elavil®)
Amitryptiline is a tricyclic antidepressant, has several studies reporting success in reducing IC symptoms. One study demonstrated a 63% significant improvement at four months. (R). Two observational long term studies reported 50% to 64% improvement.(R) Unfortunately, adverse events are extremely common making this medication more difficult to tolerate, including: dry mouth, drowsiness, cardiac arrhythmias (irregular heart rate), tachycardia (rapid heart rate) and, more recently, has been linked to cognitive decline. Grade B. Ask Questions in our Antidepressant Message Board
Cimetidine (aka Tagamet)
Cimetidine acts to inhibit acid production in the stomach and has been found helpful in the treatment of IC. Two long term studies reported that 44% to 57% of patients experienced improvement in their symptoms with no adverse events reported.(R) Grade B
Hydroxyzine (aka Vistaril, Atarax)
An antihistamine, hydroxyzine acts to reduce histaminic activity in the bladder wall. It has mixed research studies, one of which reported that 92% of patients experienced improvement yet those participating patients also had systemic allergies.(R) Other studies found much more modest effectiveness (i.e. 23%).(R) Adverse events were common and generally not serious. Grade C – Ask Questions in our Antihistamine Message Board
Pentosan polysulfate (aka Elmiron)
Elmiron is the only FDA approved oral medication for IC . Dr. Lowell Parsons believes that it works by providing a protective coating to the bladder wall that prevents urine, bacteria and other irritating substances from penetrating an otherwise “leaky” bladder lining and causing inflammation in the muscle tissue. It is the most studied medication currently in use with five placebo controlled clinical trials. The results were clinically significant with 21 to 56% effectiveness. Roughly 10 to 20% of patients experienced side effects that were “generally not serious,” including gastrointestinal upset and hair loss. In some cases, your doctor may want to monitor your liver function through periodic blood tests. Elmiron can be extremely expensive for patients who lack health insurance, in some cases costing several hundred dollars per month. Patients are encouraged to explore Drug Assistance programs to determine if they may qualify for free medication. Pentosan may have a lower efficacy in treating patients with Hunner’s Ulcers. Grade B Ask Questions In Our Elmiron Message Board
Elmiron® Now Linked With Eye Disease
Elmiron® use has now been linked with serious eye disease. A new FDA warning label was added to this product in June of 2020 warning that serious, progressive and potentially permanent damage can occur. As a result, many patients with eye damage are stopping the medication and transitioning to other, safer therapies. Learn more about that here.