Oral medications can play an important role in managing IC/BPS. These medications work in different ways: some target pain directly, while others aim to reduce inflammation or calm an overactive nervous system. Your healthcare provider may recommend one or more of these medications as part of a broader treatment plan.

Pentosan polysulfate sodium (PPS), sold under the brand name Elmiron, is the only oral medication approved by the U.S. Food and Drug Administration specifically for treating the pain and discomfort of IC/BPS. It is designed to mimic a natural protective coating on the bladder lining, called the glycosaminoglycan (GAG) layer, a mucus-like surface that shields the bladder wall from bacteria and irritants in urine. In people with IC/BPS, this layer is thought to be damaged or “leaky,” and PPS is believed to function as a synthetic replacement, though its exact mechanism of action remains unknown.

Unfortunately, evidence for Elmiron’s effectiveness is mixed, with conflicting study results. A number of studies have shown that Elmiron does not work better than a placebo (or sugar pill).

Important Safety Considerations
There are two emerging areas of concern regarding long-term PPS use that patients should discuss with their healthcare provider:

  • Eye-related effects: The FDA label for Elmiron (updated March 2021) includes a warning about pigmentary maculopathy (i.e., changes to the retina that can result in difficulty reading, slow adjustment to low-light or reduced-light environments, and blurred vision). The FDA recommends obtaining a detailed ophthalmologic history before starting Elmiron and conducting regular retinal examinations during treatment.
  • Gastrointestinal effects: While initial studies indicated only mild gastrointestinal side effects, more recent research has begun to document a potential association between Elmiron use and the development of symptoms consistent with inflammatory bowel disease or irritable bowel syndrome. These studies do not establish a causal relationship, but patients considering starting the drug—or those already taking it who experience gastrointestinal symptoms—should be aware of this emerging data and discuss it with their doctor.

PPS has not been studied in pregnant women, and the manufacturer recommends it not be used during pregnancy. Its safety and effectiveness in children have not been established.

Amitriptyline is a tricyclic antidepressant that has become a mainstay in the treatment of many chronic pain conditions, including IC/BPS. At lower doses than those used for depression, amitriptyline can help reduce pain signals, improve sleep, and decrease urinary urgency.

Some people may benefit from combining amitriptyline with supplements such as alpha-lipoic acid and omega-3 fatty acids. This combination may allow a lower dose of amitriptyline to be effective, helping reduce common side effects such as dry mouth, drowsiness, and constipation.

Hydroxyzine is an antihistamine that works by stabilizing mast cells, immune cells that release histamine and other mediators involved in inflammation and pain. Because mast cells have been implicated as a contributing factor in IC/BPS, blocking their activity may help reduce symptoms in some patients. Hydroxyzine is particularly useful for people who also have a history of allergies, as this may suggest a stronger mast cell component to their condition. Because hydroxyzine can cause drowsiness or feelings of weakness, it is usually taken at bedtime.

Recent research has explored a possible connection between IC/BPS and overactivity of the sympathetic nervous system, the body’s “fight or flight” system. Silodosin is a medication that selectively blocks certain receptors (called alpha-1A adrenoceptors) involved in this response. Originally studied for prostate conditions, silodosin has shown promise in IC/BPS, with one clinical trial finding that it improved bladder pain and urinary frequency in up to 60% of patients. It has a relatively safe profile with respect to cardiovascular side effects.

Cyclosporine is an immunosuppressive medication traditionally used to prevent organ transplant rejection and treat autoimmune diseases. It has gained attention as a treatment for severe, treatment-resistant IC/BPS, particularly in patients who have a specific type of bladder inflammation called Hunner lesions.

Cyclosporine works by suppressing certain immune cells (T-cells) that contribute to chronic inflammation in the bladder wall. Clinical studies have shown encouraging results: in one study, 75% of patients with Hunner’s lesions reported significant improvement in pain and urinary frequency after six months of treatment. Another multicenter study reported an 85% response rate among patients with Hunner’s lesions.

However, cyclosporine carries more significant potential side effects than other oral options, including elevated blood pressure and changes in kidney function. It requires regular blood monitoring and close supervision by a specialist. Its effectiveness in IC/BPS patients without Hunner lesions is less consistent, suggesting it works best for a specific subtype of the condition.

Other medications, including muscle relaxants like cyclobenzaprine, urinary analgesics, and acetaminophen, may also be used to help manage IC/BPS pain. Because no single medication works for everyone, treatment often involves trying different options or combining medications with other approaches such as pelvic floor physical therapy or stress management techniques.

Email Sign-Up

Email Sign-Up

Sign up here to receive timely and relevant email communication from the ICA, like our monthly newsletter, research digest, and important announcements for the IC/BPS community!

Name(Required)

Corporate Partners

Desert Harvest logo
Prelief logo