Antihistamines Some patients report a decrease in IC Dosage & Treatment Plan symptoms using other antihistamines or Most patients start with a 10 to 25 milligram medicines with antihistamine properties. (mg) dosage of Atarax, Vistaril or their generic Though the most widely used antihistamine to equivalent at bedtime every night for 1 week, treat IC is hydroxyzine, some people with IC and progress to 50 mg every night the second find relieve from Claritin, Benadryl, and week. Ideally, within one month the dosage is Singulair. increased to 75 mg, 50 mg taken at night and 25 mg taken during the day. Benefits of hydroxyzine may be seen within a few weeks to two months after initiating therapy.

To decrease the sedating side effects, some patients start hydroxyzine therapy at a 10 mg dosage, available with Atarax or in the liquid form, and work their way up, gradually, to a maximum dosage of 50 to 75 mg. After one year some patients are able to decrease their dosage by one-half. Others report that upon reducing their dosage, symptoms will return within a few days.

Potential Side Effects Side effects include sedation, dry mouth, and increased depression in patients diagnosed with concurrent depression. Hydroxyzine A mild anti-anxiety drug, hydroxyzine is Take this medicine early in the evening initially available in two oral forms: to avoid excessive morning drowsiness. Most  Hydroxyzine pamoate (Vistaril) patients report that daytime drowsiness  Hydroxyzine hydrochloride (Atarax) disappears within four to five days after beginning hydroxyzine therapy. Some patients Hydroxyzine affects mast cell degranulation, report that with each dosage increase, the which is thought to play a part in some IC drowsiness period is shorter and not as intense. patients’ symptoms, especially those who have a history of allergies, migraines and Pregnancy & Warnings irritable bowel syndrome. Hydroxyzine has Animal studies have found that fetal been shown to improve these conditions, as abnormalities occur at doses ten times higher well as IC. Hydroxyzine has been found to than given to humans. It is not recommended decrease: that hydroxyzine be used if pregnant or  Nocturia (night time voiding) nursing. Hydroxyzine is contraindicated for use  Daytime frequency in epileptic patients.  Pain (burning, pressure, painful intercourse) Anti-seizure Medicines Originally developed as an anti-seizure Hydroxyzine pamoate has a slightly higher medicine, gabapentin (neurontin) is also used absorption rate. Hydroxyzine-HCL is a liquid to treat nerve-related pain. Some types of IC form available for patients allergic to fillers or pain may to be generated by nerve endings dyes used in the capsules or pills. and the central nervous system. A few small studies showed that gabapentin may improve symptoms in some IC patients. Interstitial Cystitis Association © 2009 www.ichelp.org RFZ/ Updated Jul 2009 Printed Nov 2009

Histamine Blockers potential side-effects -- some serious -- so a Most antihistamines prescribed for allergy cautionary approach is necessary and more and IC are called "H1" blockers. When research is needed. histamines bind to the histamine receptors on cells, that produces an allergic reaction. The Mycophenolate (CellCept) works in the body H1 receptors aren’t the only ones that by reducing the immune system's ability to histamines go to, however. They can also bind produce certain reactions that can cause to H2 receptors, and drugs that block these inflammation, pain, and discomfort. receptors can also be helpful in calming allergic reactions. H2 blockers include Mycophenolate mofetil is approved by the . Cimetidine (Tagamet) US Food and Drug Administration (FDA) for . Ranitidine (Zantac) use in patients who have had an organ . Nizatidine (Axid) transplant. However, a large national study . Famotidine (Pepcid) sponsored by the National Institutes of Health (NIH) did not find mycophenolate mofetil to By blocking these H2 receptors in the gut, be effective for IC and the study was these medicines reduce stomach acid ultimately canceled. secretions and, thus, stomach pain. Studies with one of these H2 blockers, cimetidine, Leukotriene Inhibitors showed it reduced bladder pain as well, Leukotrienes which are substances produced maybe because of the histamine-blocking by some immune system cells and mast cells, action. But why it works in IC really isn’t so promote inflammation. Drugs that block clear. In two small studies (one with 9 and leukotrienes are fairly new and are being one with 14 patients), Tagamet reduced used in the treatment of asthma and allergy. bladder pain for 40 to 60 percent of the IC They include the prescription medicines: patients. . Montelukast (Singulair) . Zafirlukast (Accolate) In Japan, Suplatast tosilate, also known as . Zileuton (Zyflo) IPD-1151T and available is indicated for IC, as well as asthma and allergies. This medicine Some studies have implicated leukotrienes in acts somewhat earlier in the allergic process inflammation of the bladder in IC. The than histamine or leukotriene blockers do by receptors have been found in the bladder affecting IgE. Suplatast tosilate helps muscle in IC patients. A study of 10 IC suppress the production of IgE. It also helps patients in Denmark who took Singulair for to block production of cytokines and three months showed significant reductions in suppresses allergy-related eosinophils. This frequency and pain. medicine remains under investigation in the US.

Tagamet, Zantac, Axid, and Pepcid are available over the counter.

Immunosuppresants

Cyclosporine, an immunosuppressive drug The ICA provides advocacy, research used in organ transplantation, is also a funding, and education to ensure early treatment for several autoimmune disorders diagnosis and optimal care with dignity for with good results. Because IC may have an people affected by IC. autoimmune component, this medicine is being studied as a possible IC treatment. So Your donation dollars also enable the ICA to far the results of testing in humans have been continue to fund new IC research projects, encouraging, but the drug does have many as well as work closely with Congress to ensure ongoing IC-specific research funding Interstitial Cystitis Association © 2009 at the federal level. www.ichelp.org RFZ/ Updated Jul 2009 www.ichelp.org Printed Nov 2009 [email protected]