Elmiron Alternatives

Doctors may recommend oral medications, bladder instillations, nerve stimulation, bladder distention, bladder training, physical therapy and surgery as alternatives to Elmiron for the treatment of interstitial cystitis.

IC, also known as painful bladder syndrome, is a chronic condition characterized by uncomfortable symptoms such as pain in the bladder and pelvic region along with an urgent and frequent need to urinate. The exact cause of IC is unknown, but various treatments can help manage the symptoms.

Elmiron is the brand name of the drug pentosan polysulfate sodium. It is the only oral drug approved by the U.S. Food and Drug Administration to treat IC.

Why Use Elmiron Alternatives?

While some doctors still prescribe Elmiron to treat IC, patients often ask for alternatives to Elmiron due to its potential side effects. Elmiron has been linked to a serious eye condition called pigmentary maculopathy, which can lead to vision loss.

Patients allege that the manufacturer, Janseen Pharmaceuticals, did not adequately warn about this risk and other Elmiron side effects. As a result, some have filed Elmiron lawsuits.

There is no generic version of Elmiron, making it an expensive treatment option. Cost is a major reason people seek alternatives to Elmiron.

People often use tricyclic antidepressants as Elmiron alternatives to help manage pain, discomfort and urinary frequency. Tricyclic antidepressants, including amitriptyline and nortriptyline, have been shown to help reduce sleep disruptions. 

Doses of antidepressants used for IC are typically lower than the doses for treating depression. However, these medications can still have side effects, including drowsiness, dry mouth and weight gain. 

The FDA-approved antidepressant amitriptyline is most frequently prescribed off-label to treat IC symptoms as an alternative to Elmiron. Studies indicate that long-term use of amitriptyline is a viable, safe and efficient therapy for IC, as long as patients use caution to reduce side effects.

Research suggests that too much histamine in the bladder may cause pain and other symptoms in some IC patients. As an alternative to Elmiron, antihistamines might offer relief by reducing bladder inflammation and pain. Antihistamines can also help prevent frequent urination and nighttime urination. Since drowsiness is a common side effect, antihistamines may also improve sleep.

Hydroxyzine and cimetidine are the only antihistamines researched as IC treatments. It’s unknown if other antihistamines are effective.

Hydrodistension, also known as bladder distension, involves filling the bladder with a sterile liquid to stretch its walls and increase its capacity. This process reduces urination frequency and relieves pain and pressure. Relief from hydrodistension is only temporary, and some patients may not experience any relief. The procedure also carries the risk of bladder rupture and urinary tract infections. 

Bladder instillation, or a bladder wash, is a procedure in which a small amount of liquid medicine (dimethyl sulfoxide or a solution that contains heparin, steroids and a topical anesthetic) is introduced into the bladder. Bladder instillation eases irritation, relieves pain and reduces urination frequency. 

Surgery for IC is risky and usually only considered if other treatments are ineffective. Surgical procedures may involve increasing the bladder capacity or removing the bladder and creating an entirely new bladder with parts of the intestine. The surgeon may also reroute normal urine flow.

Transcutaneous electrical nerve stimulation uses gentle electrical pulses to strengthen the muscles that help control the bladder and block pain. Sacral nerve stimulation involves surgically implanting a device to stimulate the sacral nerves with mild electrical pulses. The goal of sacral nerve stimulation is to manage urinary frequency, urgency and pain.

Physical therapy – including manual therapy, biofeedback, stretching exercises and relaxation techniques – can relax and lengthen pelvic floor muscles, alleviating IC symptoms.

To avoid pain or urgency, people with IC may urinate before their bladder is full. Bladder training helps your bladder hold more urine, gradually increasing the time between urination.

Several important lifestyle changes may relieve IC symptoms. For example, avoiding potential dietary irritants such as alcohol, caffeine, acidic foods, spicy foods and artificial sweeteners can help. Because cigarettes irritate the bladder and frequent coughing increases pressure on the stomach area, smoking cessation is often recommended.

Stress doesn’t cause IC, but it can worsen symptoms. Therefore, health care providers may suggest different methods to help manage stress, including meditation and cognitive-behavioral therapy.

Physical activity, such as walking or gentle stretching exercises, can also help relieve symptoms.