{ "schema_version": 1, "kind": "condition", "id": "interstitial-cystitis", "name": "Interstitial Cystitis (Bladder Pain Syndrome)", "category": "chronic", "sources": "AUA Guideline on Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome 2022 for the indication, with the figures from Amitriptyline Hydrochloride 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683): \"The initial dose should be 10 mg - 25 mg in the evening. Doses can be increased with 10 mg - 25 mg every 3 - 7 days as tolerated Recommended doses are 25 mg - 75 mg daily in the evening.\" The 50 mg step is the same section's \"Initially 25 mg 2 times daily (50 mg daily)\". The SmPC carries no interstitial cystitis indication; that is from the urology guideline, which is not held in this corpus. · AUA Guideline on Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome 2022 · ELMIRON (pentosan polysulfate sodium) 100 mg capsules US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID f0ba651e-3d8a-11df-8fbe-119855d89593) · Egyptian National Drug Formulary - Nervous System 2025 (gabapentin monograph, Dosage Adjustment: Renal Impairment) · Interstitial Cystitis - disease-level clinical article (interstitial-cystitis-clinical.txt)", "review_status": "reviewed", "verified_against": "AUA Guideline on Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome 2022 for the indication, with the figures from Amitriptyline Hydrochloride 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683): \"The initial dose should be 10 mg - 25 mg in the evening. Doses can be increased with 10 mg - 25 mg every 3 - 7 days as tolerated Recommended doses are 25 mg - 75 mg daily in the evening.\" The 50 mg step is the same section's \"Initially 25 mg 2 times daily (50 mg daily)\". The SmPC carries no interstitial cystitis indication; that is from the urology guideline, which is not held in this corpus. · AUA Guideline on Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome 2022 · ELMIRON (pentosan polysulfate sodium) 100 mg capsules US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID f0ba651e-3d8a-11df-8fbe-119855d89593) · Interstitial Cystitis/Bladder Pain Syndrome - disease-level clinical article (interstitial-cystitis-clinical.txt) · Egyptian National Drug Formulary - Nervous System 2025 (gabapentin monograph, Dosage Adjustment: Renal Impairment) · Interstitial Cystitis - disease-level clinical article (interstitial-cystitis-clinical.txt)", "verified_date": "2026-09", "treatments": [ { "id": 998, "generic": "Amitriptyline", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10-25 mg once daily at bedtime, titrate by 10-25 mg every 2-4 weeks up to 50-75 mg daily", "adult_duration": "long-term", "dose_source": "AUA Guideline on Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome 2022 for the indication, with the figures from Amitriptyline Hydrochloride 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683): \"The initial dose should be 10 mg - 25 mg in the evening. Doses can be increased with 10 mg - 25 mg every 3 - 7 days as tolerated Recommended doses are 25 mg - 75 mg daily in the evening.\" The 50 mg step is the same section's \"Initially 25 mg 2 times daily (50 mg daily)\". The SmPC carries no interstitial cystitis indication; that is from the urology guideline, which is not held in this corpus.", "rationale": "Tricyclic antidepressant used at low dose for its central and peripheral pain-modulating and anticholinergic effects rather than as an antidepressant, calming the bladder pain and urgency of interstitial cystitis. First-line oral neuromodulator per AUA guidance.", "cautions": [ "Amitriptyline is the first-line oral neuromodulatory medication for bladder pain syndrome.", "Anticholinergic side effects include sedation, dry mouth, and constipation; administer at bedtime.", "Contraindicated in recent myocardial infarction and cardiac arrhythmia.", "Avoid in elderly patients, and in severe cardiovascular disease or arrhythmias. Amitriptyline - StatPearls - NCBI Bookshelf (NBK537225) puts amitriptyline on the American Geriatrics Society's Beers list, to be avoided in the elderly because its anticholinergic effect is so strong." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric urology referral", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "TRYPTIZOL 10 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 10.0, "pack_count": 20, "unit_price": 0.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRYPTIZOL 10 MG 60 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 30.0, "pack_count": 60, "unit_price": 0.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANITYLLIN 25MG/5ML SYP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRAND PHARMA > DELTA GRAND PHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ZINOTRAVAL 25MG/5ML SYP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > PHARMACHEMIC", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "interstitial-cystitis" }, { "id": 1001, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Interstitial Cystitis/Bladder Pain Syndrome - disease-level clinical article (interstitial-cystitis-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - unexplained hematuria or significant smoking history requires evaluation to exclude bladder malignancy before/while treating as IC/BPS." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "interstitial-cystitis" }, { "id": 999, "generic": "Cimetidine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "300-400 mg twice daily orally", "adult_duration": "long-term", "dose_source": "AUA Guideline on Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome 2022", "rationale": "Oral cimetidine is not registered or marketed in Egypt; available only as IM/IV injection.", "cautions": [ "Cimetidine is an H2-receptor antagonist that reduces bladder mucosal mast cell activation.", "Inhibits hepatic CYP450 enzymes; inspect for drug interactions." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist use only", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CIMETIDINE 200MG/2ML I.M/I.V.AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 14.4, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "interstitial-cystitis" }, { "id": 1000, "generic": "Pentosan polysulfate sodium", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg three times daily taken with water 1 hour before or 2 hours after meals", "adult_duration": "long-term (3-6 months trial minimum)", "dose_source": "ELMIRON (pentosan polysulfate sodium) 100 mg capsules US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID f0ba651e-3d8a-11df-8fbe-119855d89593)", "rationale": "Pentosan polysulfate sodium is not registered or marketed in Egypt.", "cautions": [ "Restores damaged glycosaminoglycan (GAG) layer of bladder urothelium.", "Requires baseline and annual ophthalmologic examination due to risk of pigmentary maculopathy.", "Pentosan polysulfate sodium has weak anticoagulant activity; caution with concurrent NSAIDs or anticoagulants.", "This drug causes a pigmentary maculopathy. Get a baseline retinal examination within six months of starting - fundus photography, OCT, autofluorescence - and repeat it periodically. Any change in vision means stop and look, not wait and see.", "Reassess at three months. Another three is reasonable if it is helping. Past six months with no improvement, nobody knows whether continuing does more good than harm.", "It has antiplatelet activity. Take care before invasive procedures and alongside warfarin, heparin, high-dose aspirin or an NSAID.", "Pentosan polysulfate sodium is unregistered and unavailable in Egyptian retail pharmacies." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated in children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "HEMOFLUSH 0.5% OINT. 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > PHARMACARE", "price_egp": 6.5, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "HEMOCURE 0.5% GEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 7.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "HEMOCLAR 0.5% CREAM 40 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI > CHEMIPHARM", "price_egp": 46.0, "pack_count": null, "unit_price": null, "strength_mg": 40000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "HEMOCLAR 0.5% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI > CHEMIPHARM", "price_egp": 58.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "interstitial-cystitis" }, { "id": 1002, "generic": "Gabapentin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "300 mg TID, titrated up to a maximum of 1,200 mg TID", "adult_duration": null, "dose_source": "Interstitial Cystitis (Bladder Pain Syndrome) - disease-level clinical article (interstitial-cystitis-clinical.txt)", "rationale": "Oral neuromodulatory agent used for chronic neuropathic pain control in interstitial cystitis/bladder pain syndrome.", "cautions": [ "Alternative to the amitriptyline above, not an addition. NICE offers a choice of one.", "It must be titrated. A patient started straight on 300 mg three times daily will be too drowsy to continue.", "Reduce the dose in renal impairment - gabapentin is cleared by the kidney and accumulates. The ENDF's own gabapentin monograph scales the daily dose to the creatinine clearance, halving it at a clearance of 7.5 mL/min. The same monograph carries a creatinine-clearance dose table and a haemodialysis schedule.", "Drowsiness, dizziness and unsteadiness are common early and matter in an elderly patient who may fall." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Initial range: 10 to 15 mg/kg/day, given in three divided doses.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "GABA 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX > MULTIPHARMA", "price_egp": 6.5, "pack_count": 10, "unit_price": 0.65, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PENTALIPSY 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAFE PHARMA", "price_egp": 8.0, "pack_count": 10, "unit_price": 0.8, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EZAPENTIN 300MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GABAPENTIN 300 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "price_egp": 96.0, "pack_count": 30, "unit_price": 3.2, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANDOPENTENE XR 300 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 90.0, "pack_count": 20, "unit_price": 4.5, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CONVENTIN 600 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 171.0, "pack_count": 30, "unit_price": 5.7, "strength_mg": 600.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GABAVERONA 400 MG 30 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 156.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SAJALIPSY 400 MG 30 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAJA PHARMACEUTICALS", "price_egp": 156.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STABLENTIN 6MG/120ML SYRUP", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 21.6, "pack_count": null, "unit_price": null, "strength_mg": 6.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 37.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "interstitial-cystitis" }, { "id": 1003, "generic": "Hydroxyzine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "50 mg to 100 mg four times daily", "adult_duration": "long-term", "dose_source": "Interstitial Cystitis - disease-level clinical article (interstitial-cystitis-clinical.txt)", "rationale": "The article lists hydroxyzine among initial oral pharmacotherapy for interstitial cystitis and bladder pain syndrome, and says patients with allergies are the most likely to benefit. It prevents mast cell degranulation. The dose is the article's own.", "cautions": [ "Hydroxyzine prolongs the QT interval. Avoid it in known QT prolongation, in a patient on another QT-prolonging drug, and where potassium or magnesium is low. MSF Essential Drugs contraindicates it on this basis and caps its own dose lower, at 25 to 50 mg twice daily. The dose above is the higher one, so the ceiling deserves a second look in an older patient or one taking several drugs.", "Sedation and weakness are the usual adverse effects. Warn about driving.", "Anticholinergic load: caution in glaucoma, prostatic enlargement and in the elderly.", "Practical point for Egypt: only the 10 mg Atarax tablet is still marketed - the 25 mg carries the (N/A) withdrawn marker. At this dose that is 5 to 10 tablets per dose, four times a day. Check what the pharmacy can actually supply before writing it." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not a primary-care paediatric indication; refer.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ATARAX 10 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 22.0, "pack_count": 20, "unit_price": 1.1, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "interstitial-cystitis" } ] }