Medications
Learn about medications that can help relieve your IC/BPS symptoms.
Medications for IC/BPS
IC Pain Medicines
When your pain is relenting, out of control, and the IC/BPS treatments you’re getting still don’t bring it down, do you have anywhere left to turn?
Yes. Some of the worst pain can be controlled. To treat IC/BPS pain, healthcare providers recommend a variety of medications, including both non-prescription and prescription medicines.
Over-the-counter medicines are available without a prescription at drug stores and pharmacies and are helpful for mild to moderate pain. Ask your doctor if any of the following medicines might be helpful for your pain:
- Aspirin (Bufferin, Ecotrin)
- Acetaminophen (Tylenol, Datril)**
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Ibuprofen (Advil, Motrin and Nuprin)
- Ketoprofen (Orudis)
- Naproxen sodium (Aleve and Anaprox)
Common side effects: Aspirin and other NSAIDs may cause stomach irritation, asthmatic and/or allergic reactions, and/or damage to the kidneys. And are generally not recommended if you have stomach ulcers, asthma, or are allergic to aspirin. If taken in excess of recommended dosage, acetaminophen can cause liver damage. Do not take acetaminophen with alcohol or if you suffer from liver disease.
**The FDA has expressed concern over acetaminophen regulations. Click here to read more about these concerns.
There are several non-opiod medicines currently available that are used to relieve symptoms caused by irritation of the urinary tract such as pain, burning, the feeling of needing to urinate urgently or frequently, and bladder spasms. These are also commonly used for pain associated with urinary tract infections.
- Urelle Oral
- Uribel™ (analgesic, antispasmodic, and antiseptic combination)
- Utira
Medicines that are applied topically as gels, creams, suppositories and patches, may cause fewer systemic side effects. Used alone or in combination formulas, these medicines sometimes require the expertise of a compounding pharmacist. Examples of topicals used to treat IC symptoms include:
- Lidocaine patch (Lidoderm): Some patients report success with the patch form of the anesthetic (numbing agent) Lidocaine, which is available by prescription in an adhesive patch.
- Vaginal and rectal diazepam (Valium) suppositories: Vaginal diazepam for women with IC and rectal diazepam for men with IC offer alternatives to oral Valium. Available by prescription through compounding pharmacies, these suppositories relax the muscles in the pelvic floor. The tablet form of Valium inserted into the vagina or rectum seems to work as effectively as the compounded formula.
- Topical amitriptyline (Elavil): Oral amitriptyline is a standard IC therapy. In gel form, applied to the skin, Elavil may offer relief without the unwanted side effects of the oral medicine.
Narcotic Pain Medicines used for moderate pain include:
- Codeine: Sometimes combined with aspirin or acetaminophen
- Hydrocodone: Lortab and Vicodin (combined with acetaminophen), Lorcet Zydone (combined with acetaminophen)
- Oxycodone: Percodan (combined with aspirin), Percocet, Tylox (combined with acetaminophen)
- Oxymorphone (Opana): Similar to morphine, includes extended-release form for around-the-clock treatment of pain
Opioids used for severe pain include:
- Morphine
- Hydromorphone: Dilaudid
- Levorphanol: Levo-Dromoran
- Methadone: Dolophine
- Oxycodone
- Oxymorphone
- Tapentadol: Nucynta
Long-acting opioids are generally used for IC patients who experience unremitting or frequently recurring pain. These long-acting medications are not combined with other medications such as acetaminophen or aspirin, thus reducing potential problems or side effects. They are controlled-release, meaning that they require less of a maintenance schedule, as the dosage is gradually released into the patient’s system. IC patients receiving long-acting opioids should be supplied with a fast-acting opioid “rescue drug” (e.g. Vicodin, Lorcet. etc.) for breakthrough pain, which occurs unpredictably, or when the long-acting opioid starts to wear off, prior to the time of the next scheduled dose. Examples of controlled release opioid preparations:
- Long-acting morphine: MS Contin, Oramorph, Opana
- Long-acting oxycodone: OxyContin
- Levorphanol: Levo-Dromoran
- Methadone: Dolophine
- Fentanyl: Duragesic patch
Possible side effects: constipation, nausea, itching, edema, sedation, muscle spasms and possible respiratory depression. Ask your healthcare provider for advice on reducing side effects. Tolerance and physical dependency may occur.
The American Academy of Family Physicians mentions these potential warning signs of opioid medication overdose:
- Stumbling while walking.
- Feeling dizzy.
- Slurring your speech.
- Feeling confused.
- Slow breathing and heartbeat.
- Blue nails or lips.
- Pale or clammy skin.
- Feeling excessively drowsy or having trouble staying alert.
- Having trouble waking from sleep.
Other Medicines
A list of other medicines that may be prescribed to relieve IC/BPS symptoms follows. Each of these classes of medicines comes with its own set of side effects and drug interactions. Remember to always make sure that you check with your doctor before trying any new medicine or therapy.
Certain alpha blockers are used to treat benign prostatic hyperplasia (prostate enlargement) in men in the United States. The drugs include:
- Doxazosin (Cardura)
- Terazosin (Hytrin)
- Tamsulosin (Flomax)
Two of these, Cardura and Hytrin, and another not on the US market, alfuzosin, have been studied in chronic prostatitis and have been found to help reduce overall symptoms or pain.
Researchers are discovering that many men with this condition have glomerulations or Hunner’s ulcers on the bladder walls, and some researchers think that IC and chronic prostatitis (at least for a subset of men with chronic prostatitis) may really be the same. This is why some doctors are also trying these alpha blocker medicines in women with IC.
Dextroamphetamine sulfate (Desedrine)is a stimulant that promotes wakefulness and reduces appetite. It is approved for use in attention deficit hyperactivity disorder (ADHD) and narcolepsy. In 2005, case reports of two women with IC found dexamphetamine to be helpful in treating their symptoms. The hypothesis is that dextroamphetamine may help certain people with IC who experience idiopathic edema, a type of swelling of bodily tissues due to excess fluid retention.
Originally developed as an anti-seizure medicine, gabapentin (neurontin) is also used to treat nerve-related pain. Some types of IC pain may to be generated by nerve endings and the central nervous system. A few small studies showed that gabapentin may improve symptoms in some IC patients.
Most antihistamines prescribed for allergy and IC are called “H1” blockers. When histamines bind to the histamine receptors on cells, that produces an allergic reaction. The H1 receptors aren’t the only ones that histamines go to, however. They can also bind to H2 receptors, and drugs that block these receptors can also be helpful in calming allergic reactions. H2 blockers include
- Cimetidine (Tagamet)
- Ranitidine (Zantac)
- Nizatidine (Axid)
- Famotidine (Pepcid)
By blocking these H2 receptors in the gut, these medicines reduce stomach acid secretions and, thus, stomach pain. Studies with one of these H2 blockers, cimetidine, showed it reduced bladder pain as well, maybe because of the histamine-blocking action. But why it works in IC really isn’t so clear. In two small studies (one with 9 and one with 14 patients), Tagamet reduced bladder pain for 40 to 60 percent of the IC patients.
In Japan, Suplatast tosilate, also known as IPD-1151T and available is indicated for IC, as well as asthma and allergies. This medicine acts somewhat earlier in the allergic process than histamine or leukotriene blockers do by affecting IgE. Suplatast tosilate helps suppress the production of IgE. It also helps to block production of cytokines and suppresses allergy-related eosinophils. This medicine remains under investigation in the US.
Tagamet, Zantac, Axid, and Pepcid are available over the counter.
Leukotrienes which are substances produced by some immune system cells and mast cells, promote inflammation. Drugs that block leukotrienes are fairly new and are being used in the treatment of asthma and allergy. They include the prescription medicines:
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
Some studies have implicated leukotrienes in inflammation of the bladder in IC. The receptors have been found in the bladder muscle in IC patients. A study of 10 IC patients in Denmark who took Singulair for three months showed significant reductions in frequency and pain.
Misoprostol (Cytotec) is an oral prostaglandin (a protective hormone-like substance found throughout the body). It inhibits the secretion of stomach acid and is often given to counteract the side effects of certain pain relievers such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) like naproxen sodium (Naprosyn) or ibuprofen (Motrin), which can cause gastrointestinal problems. One European study found that misoprostol may help to treat IC by reducing inflammation.
Citrates, which include potassium or sodium citrate, tricitrates, and citric acid, either alone or in combination (Bicitra, Citrolith, Oracit, Polycitra, Urocit-K), are usually used to prevent certain types of kidney stones. But because they make the urine less acidic, they may help relieve bladder pain. These are available by prescription.
Antimuscarinics are drugs that help relax muscles in the bladder and urinary tract and may help with urinary frequency and urgency. These medicines include:
- Detrol LA
- Ditropan XL
- Flavoxate (Urispas)
- Gelnique
- Sanctura
- Toviaz
- VESIcare