For some IC patients, frequency of urination is their most troubling symptom. Other IC patients experience bladder spasms and resulting pain as a main component of their IC symptoms. For others, occasional urinary tract infections intensify the symptoms of IC. In addition to the traditional oral medications used to treat IC (Elmiron®, Elavil®, Atarax®, etc.), other oral medications may help with occasional IC flare-ups and the symptoms of urinary tract infections.
While not specifically designed to treat IC, several different types of medications may be helpful in treating these related symptoms. Some of these contain single active ingredients, while others combine several different medications to help to relieve more symptoms. These medications may not work for all IC patients because they can cause urinary retention (difficulty in urinating), which may already be a problem for some IC patients. They can also cause dry eyes and mouth, which can be troublesome for IC patients with co-existing conditions such as Sjogren’s Syndrome.
It is important to remember that these medications are for symptom management only, and are not disease-specific therapies. You will need to continue with your standard IC therapies while taking these medications as needed. Before taking any of the following medications, be sure to discuss their uses with your physician and make sure that they will not interfere with any medications that you may be currently taking. Also, be sure that your physician knows about any other medications or supplements that you are taking.
Antispasmodics, Pain Relievers, and Antiseptics
Newer treatments on the market are designed to combine antispasmodic ingredients with pain relieving components and urinary antiseptics. Antispasmodics, or anticholinergics, block the passage of nerve impulses through the parasympathetic nervous system (involuntary muscles such as those found in the bladder, gastrointestinal tract, etc.). The effects of these medications may include relaxation of the bladder and decreased intensity of bladder contractions.
The antispasmodics/anticholinergics group includes the natural belladonna alkaloids (atropine, belladonna, hyoscyamine, and scopolamine) and related products. These medications are often incorporated into other products that are sometimes used to treat the symptoms of interstitial cystitis. These medicines may also be used for other conditions, as determined by your doctor.
Pyridium-Plus® [Warner Chilcott]
Pyridium-Plus (available by prescription only) is a combination of a pain reliever, an antispasmodic and butabarbital, which is a sedative. Butabarbital can be very sedating when initiating therapy, but this effect usually diminishes over time. Typically used for the discomfort of UTIs, Pyridium-Plus may help some IC patients manage their symptom flares. Butabarbital can be habit-forming, therefore this medication should not be taken for extended periods of time.
Ingredients: phenazopyridine hydrochloride (urinary analgesic), hyoscyamine (antispasmodic), and butabarbital (sedative).
Most Common Side Effects: Headache, itching, rash, severe allergic reaction, upset stomach. Pyridium-Plus should be avoided if you have kidney disease, or if you are sensitive to or have ever had an allergic reaction to it. This medication may cause drowsiness and therefore caution should be taken while driving. Pyridium-Plus produces an orange to red color in urine, and may stain fabric. Staining of contact lenses has also been reported.
An ingredient in Pyridium-Plus, butabarbital, is chemically related to phenobarbital. It has been found that pretreatment or concurrent administration of phenobarbital may decrease the effects of oral contraceptives by increasing their metabolism. There have been reports of patients treated with phenobarbital who become pregnant while taking oral contraceptives. An alternative birth control method should be considered while taking this medication.
Pyridium® [Warner Chilcott]
Pyridium (available by prescription, and in an over-the counter lower dose formula) is a non-narcotic urinary tract analgesic used for short-term relief of bladder pain. Pyridium helps relieve the pain, burning, urgency, frequency, and irritation caused by infection, trauma, catheters, or various surgical procedures in the lower urinary tract. Pyridium is indicated for short-term use only.
Ingredients: phenazopyridine hydrochloride.
Side Effects: Headache, itching, rash, severe allergic reaction, upset stomach. Pyridium should be avoided if you have kidney disease, or if you are sensitive to or have ever had an allergic reaction to it. This medication should not be taken over extended periods of time. Pyridium produces an orange to red color in urine, and may stain fabric. Staining of contact lenses has also been reported.
Urised® [Polymedica]
Urised (available by prescription only) combines urinary antiseptics with antispasmodics to help to relieve the discomfort of urinary inflammation and pain. Urised relieves lower urinary tract discomfort caused by inflammation or diagnostic procedures. It is often used in conjunction with antibiotics to treat urinary tract infections.
Ingredients: methenamine (antiseptic), phenyl salicylate (pain reliever), methylene blue (antiseptic), benzoic acid (antiseptic), atropine sulfate (antispasmodic), hyoscyamine (antispasmodic).
Most Common Side Effects: Dry nose, mouth, and throat, dizziness, difficulty in urinating. Urised may give a blue to blue-green color to urine and discolor stools as well. This medication should not be taken over an extended period of time. To avoid stains on your skin, mouth, or teeth, make sure your hands are dry before handling the tablets, swallow them quickly, and wash them down with plenty of liquid.
If bladder spasms, causing urinary urgency and frequency, are your main IC symptoms (and pain is not a significant component), you may want to try one of the following medications. These medications are sometimes used to treat incontinence and "over-active" bladder, as well.
Examples of antispasmodic/anticholinergic medications include:
- oxybutinin: Ditropan®, Ditropan XL® (extended-release formula) – Alza;
- tolterodine: Detrol®, Detrol LA® (time-released) – Pharmacia;
- Levsin®, Levbid® (sublingual), Levsinex® (time-released) – Schwarz;
- hyoscyamine: Cystospaz®, Cystospaz-M® (time-released) – Polymedica;
- flavoxate: Urispas® – SmithKline Beecham;
- dicyclomine: Bentyl® – Hoechst Marion Roussel;
- propantheline: Pro-Banthine® – Roberts <
Many of the medications discussed in this article can cause dry mouth, urinary retention and other side effects. If you experience dry mouth while taking these medications, you may want to try hard candy or gum, saliva substitute, or crushed ice to provide temporary relief. If you are concerned about tooth decay from sugary hard candies, but cannot tolerate artificial sweeteners, you may want to try Biotene® mouth care products. Biotene products include Dry Mouth® toothpaste, gentle mouth-wash, dry mouth gum, and Oral Balance® moisturizing gel. These products use Xylitol®, a natural sweetener, which has been found to prevent tooth decay. Also, drinking adequate fluids will help the medication work better and relieve discomfort.
You may find that bladder antispasmodics, pain relievers, relaxants, antiseptics, and anticholinergics will be helpful in treating your IC flares or concurrent urinary tract infections. Many of these medications can be taken along with your standard IC treatments. However, please keep in mind that these treatments are for symptom management only, and are not disease-specific therapies. They are designed for occasional flare-ups. Please be sure to check with your physician before using any of these products.
ICA Update, January/February 2002