From the Research
Hydroxyzine may be prescribed off-label for interstitial cystitis at doses of 25-50 mg orally three to four times daily, with some clinicians starting at a lower dose of 10-25 mg and gradually increasing based on patient response and tolerance. The medication works as an antihistamine with anticholinergic properties that may help reduce bladder pain and urinary frequency associated with interstitial cystitis 1. When taking hydroxyzine, patients should be aware that it commonly causes sedation, so it's often best taken at bedtime initially until tolerance to this side effect develops. Elderly patients typically require lower doses due to increased sensitivity to anticholinergic effects. Hydroxyzine should be used cautiously in patients with cardiac conditions as it may prolong the QT interval. The therapeutic effect for interstitial cystitis symptoms may take several weeks to become fully apparent, so patients should continue the medication as prescribed even if immediate relief isn't experienced.
Some key points to consider when prescribing hydroxyzine for interstitial cystitis include:
- Starting with a lower dose and gradually increasing as needed and tolerated
- Monitoring for sedation and other side effects, particularly in elderly patients
- Using caution in patients with cardiac conditions due to the potential for QT interval prolongation
- Encouraging patients to continue the medication for several weeks to allow for full therapeutic effect
It's also important to note that while hydroxyzine may be effective for some patients with interstitial cystitis, it is not FDA-approved for this specific indication, and other treatments such as pentosan polysulfate sodium may also be considered 2. However, based on the available evidence, hydroxyzine at doses of 25-50 mg orally three to four times daily is a reasonable off-label treatment option for interstitial cystitis, particularly in patients who have not responded to other therapies or who have a history of allergies or bladder mast cell activation 3.