From the Guidelines
Treatment options for eosinophilic cystitis and interstitial cystitis should be individualized and based on the unique characteristics of each patient, with a focus on behavioral/non-pharmacologic, oral medicines, bladder instillations, procedures, and major surgery, as recommended by the 2022 updated Guideline 1.
Overview of Treatment Options
Treatment for these conditions includes both pharmacological and non-pharmacological approaches.
- For eosinophilic cystitis, antihistamines like hydroxyzine and corticosteroids such as prednisone are first-line treatments to reduce inflammation.
- For interstitial cystitis, oral medications include pentosan polysulfate sodium, amitriptyline, and hydroxyzine.
- Bladder instillations with dimethyl sulfoxide (DMSO), heparin, or lidocaine can provide direct relief.
Non-Pharmacological Approaches
Both conditions benefit from:
- Dietary modifications (avoiding acidic foods, caffeine, alcohol)
- Pelvic floor physical therapy
- Stress management techniques
Pain Management
Pain management may include NSAIDs or gabapentinoids like pregabalin.
Severe Cases
More severe cases may require immunosuppressants like cyclosporine or surgical interventions such as hydrodistention or, rarely, partial or complete cystectomy, as noted in previous guidelines 1. However, the most recent guideline 1 emphasizes the importance of individualized treatment and shared decision-making, highlighting the need for a personalized approach to managing these complex conditions.
From the FDA Drug Label
ELMIRON® is used to treat the pain or discomfort of interstitial cystitis (IC). Instillation of 50 mL of RIMSO-50® (dimethyl sulfoxide) directly into the bladder may be accomplished by catheter or asepto syringe and allow to remain for 15 minutes.
Some treatment options for interstitial cystitis are:
- Pentosan polysulfate (PO), such as ELMIRON® capsules, taken orally three times a day 2
- Dimethyl sulfoxide (IV), such as RIMSO-50®, instilled directly into the bladder every two weeks until maximum symptomatic relief is obtained 3
There is no information in the provided drug labels about treatment options for eosinophilic cystitis.
From the Research
Treatment Options for Eosinophilic Cystitis
- The treatment of eosinophilic cystitis is not standardized due to its rare occurrence, but various options have been explored, including nonsteroidal anti-inflammatory drugs (NSAIDs) 4, corticosteroids, antihistaminics, and antibiotics 5, 6.
- Transurethral resection of the bladder lesion is also a common approach, often combined with medical therapy 5, 6.
- In some cases, partial or total cystectomy may be considered, especially for patients with unresponsive disease and hematuria 6.
Treatment Options for Interstitial Cystitis
- Pentosan polysulfate sodium (PPS) has been shown to be efficacious in the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), with significant improvements in patient's overall response assessment, pain, and urgency 7.
- PPS is believed to repair the damaged glycosaminoglycane layer on the urothelium of the urinary bladder, and its efficacy has been proven in randomized trials 8.
- PPS is recommended as a basic pharmaceutical therapy for IC/BPS, in addition to behavioral intervention, dietary therapy, or other drug treatments such as pain therapy 8.
- However, PPS may have side effects, including mild haemodilution, nausea, and loss of hair, and there is a potential correlation with maculopathy, although this is still unclear 8.