What medications are used to treat cystitis pain?

Medications for Cystitis Pain

Phenazopyridine is the first-line medication for symptomatic relief of cystitis pain, providing rapid relief of pain, burning, urgency, and frequency within 6-12 hours of administration. 1, 2, 3

First-Line Pain Relief Options

• Phenazopyridine (Pyridium):

  • Dosage: 200 mg three times daily for up to 2 days
  • Mechanism: Provides direct analgesic effect on the urinary tract mucosa
  • Important note: Causes orange/red discoloration of urine (patients should be warned)
  • Should not delay definitive treatment of underlying cause
  • Treatment should not exceed 2 days 1

• Over-the-counter options recommended in guidelines:

  • Calcium glycerophosphates
  • Nutraceuticals 4

Medications for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)

For chronic cystitis pain associated with IC/BPS, the American Urological Association recommends:

1. Amitriptyline (Grade B evidence):

   • Start at low dose (10 mg) and titrate gradually to 75-100 mg if tolerated
   • Superior to placebo for IC/BPS symptoms
   • Common side effects: sedation, drowsiness, nausea 4

2. Cimetidine (Grade B evidence):

   • Shown to provide clinically significant improvement of IC/BPS symptoms, pain, and nocturia
   • Minimal reported adverse effects 4

3. Hydroxyzine (Grade C evidence):

   • More effective in patients with systemic allergies
   • Common side effects: short-term sedation, weakness 4

4. Pentosan polysulfate (Grade B evidence):

   • Only FDA-approved oral agent for IC/BPS
   • Mixed evidence on effectiveness
   • Important: Patients should be counseled about potential risk for macular damage and vision-related injuries 4

Antibiotics for Underlying Infection

When cystitis pain is due to bacterial infection, appropriate antibiotics should be used alongside pain management:

• First-line options:
  • Nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5 days)
  • Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days)
  • Fosfomycin trometamol (3 g single dose) 5

Non-Pharmacological Approaches

• Application of heat or cold over the bladder or perineum
• Pelvic floor muscle relaxation
• Stress management techniques
• Bladder training with urge suppression
• Dietary modifications (avoiding bladder irritants) 4

Clinical Pearls and Pitfalls

• Important caveat: Pain management alone is insufficient for treating cystitis; the underlying cause must be addressed simultaneously 4
• Avoid opioids: Non-opioid alternatives should be used preferentially due to the global opioid crisis 4
• Treatment duration: Phenazopyridine should not be used for more than 2 days as there's no evidence that combined administration with antibiotics provides greater benefit than antibiotics alone after this period 1
• Follow-up: If symptoms do not resolve or recur within 2 weeks, urine culture and antibiogram should be obtained 5
• Research evidence: Clinical studies show phenazopyridine significantly reduces pain intensity (by >50%) within 12 hours of administration compared to control groups 2, 3

Remember that cystitis is typically a chronic condition requiring dynamic management, and adequate symptom control may require trials of multiple therapeutic options to identify the most effective regimen for each patient.