While there is currently only one oral medication specifically approved for the treatment of interstitial cystitis, several off-label medications are used for this condition.

Interstitial cystitis (IC) is a chronic bladder condition that causes painful urinary symptoms, as well as an increased frequency and urge to urinate.

There’s no single treatment for IC, and a doctor will likely recommend a combination of medications, bladder training, and lifestyle changes. Here’s what you need to know about the options, how they work, and what side effects to consider.

When treating IC, a doctor may focus on treatments for pain management. Pain medications are used on a temporary basis only, while other drugs may be more appropriate for long-term management of IC.

Speak with a doctor about the following oral medications typically used to treat IC.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Over-the-counter (OTC) NSAIDs may be recommended on a short-term basis to help relieve mild to moderate IC pain. These may cause stomach or kidney damage, so long-term use is not recommended.

Examples of NSAIDs include aspirin (Bayer, Enteric, St. Joseph) and ibuprofen (Advil, Motrin IB).

Acetaminophen

Acetaminophen (Tylenol) is another OTC option a doctor might recommend you try for bladder pain relief. This may also be a better option if you have a history of stomach ulcers or kidney disease.

However, acetaminophen can cause liver damage (especially if you take it with alcohol), and it is not recommended if you have a history of liver disease.

Narcotics or opioids

If OTC pain relievers don’t help your IC symptoms, or if you’re in more severe pain, a doctor may prescribe narcotics or opioids. These are used on a short-term basis only due to the risk of dependence.

Possible options include hydrocodone (Norco, Vicodin) and oxycodone (Oxycontin, Oxypro).

Tricyclic antidepressants

Tricyclic antidepressants may be used to help treat pain and reduce urination frequency from IC. One example is amitriptyline (Elavil). This medication may cause a range of side effects, including:

  • allergic reactions
  • hepatitis
  • suicidal thoughts

Antihistamines

While IC has no clear cause, it’s thought that having allergies may increase your risk of developing this condition.

Taking OTC antihistamines may help relieve IC symptoms in some people. These include H1 receptor antihistamines like cetirizine (Zyrtec) and diphenhydramine (Benadryl). Side effects include:

  • dizziness
  • sleepiness
  • dry mouth

H2 receptor antihistamines are also sometimes used to treat IC and are traditionally for the treatment of acid reflux and heartburn. Examples include cimetidine (Tagamet) and famotidine (Pepcid). These may cause diarrhea and constipation in some people.

Pentosan polysulfate sodium (Elmiron)

Elmiron works by repairing the bladder lining to help reduce IC symptoms. First approved by the FDA in 1996, Elmiron is currently the only oral medication on the market exclusively intended for IC treatment.

Possible side effects associated with this treatment include:

  • rashes
  • gastrointestinal upset
  • headaches

Cyclosporine

Cyclosporine (Gengraf, Neoral, Sandimmune) is an immunosuppressant drug that is sometimes used to treat IC. It may not be a first-line of treatment due to side effects like:

  • increased infections
  • liver damage
  • kidney damage

However, research suggests cyclosporine may be most appropriate for people who have both IC and bladder ulcers called Hunner lesions.

Also called a bladder wash, bladder bath, or bladder instillation, this treatment method involves delivering medications in liquid form directly to your bladder through a catheter. The primary purpose is to reduce irritation, and it may be combined with oral medications as part of an IC treatment plan.

A doctor may use one of the following medications as part of bladder instillation. Once the medication is delivered to your bladder, you hold it in and release it after 15 minutes. You may need to repeat your treatment as often as once a week for up to 2 months at a time.

All types of bladder instillation may be uncomfortable at first, but discomfort may ease after the first administration.

Dimethyl sulfoxide (Rimso-50)

This anti-inflammatory medication may help reduce swelling and pain in the bladder. One common side effect is the taste of garlic in your mouth, which can last for up to 72 hours following treatment.

Solution of lidocaine, sodium bicarbonate, and steroids or heparin

In addition to dimethyl sulfoxide, a doctor might create a combination of other medications. These include lidocaine for pain relief, steroids, or heparin. These are thought to help boost the effectiveness of dimethyl sulfoxide treatment.

Other potential options

While not currently FDA-approved, there are other possible bladder instillation treatments for IC being investigated in clinical trials. Among these include Bacille Calmette-Guerin, a type of immune-system booster, and hyaluronic acid to help repair the bladder lining.

In addition to medications, a doctor will recommend other therapies and lifestyle changes. These include:

What is the first-line treatment for interstitial cystitis?

First-line treatment for IC usually involves a combination of OTC pain medications, physical therapy, and bladder training, along with lifestyle changes. If these do not improve your symptoms, a doctor may consider prescription medications.

What is the best medication for interstitial cystitis?

There’s no single best medication for IC, and not all treatments work for everyone with this condition. Instead, a doctor will recognize that treatment is highly individual, and you may need to try a combination of medications or new treatments altogether until you find what works best.

What is the newest drug for interstitial cystitis?

New treatment options for IC are being researched via clinical trials. Some potential options include botulinum toxin A injections, hyaluronic acid, and clorpactin.

IC management involves a treatment plan that may consist of a combination of medications, therapies, and lifestyle modifications.

No single medication is known to work for everyone with IC, so it may take some trial and error until you and a doctor find what works best for you. Medication options include pain relievers, bladder instillations, and off-label treatments.

If you are still experiencing bladder pain from IC despite treatment, consider seeing a doctor for a follow-up.