# Interstitial Cystitis (Bladder Pain Syndrome) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-09 ## 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) ## Treatment metadata - Amitriptyline — 10 mg — oral.solid - Referral & safety-netting (no drug therapy) - Cimetidine — 400 mg — oral.solid - Pentosan polysulfate sodium — 100 mg — oral.solid - Gabapentin — oral.solid - Hydroxyzine — oral.solid ## Complete treatment card ```text INTERSTITIAL CYSTITIS (BLADDER PAIN SYNDROME) 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 against 5 sources listed above (2026-09) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (10) - Suprapubic pain, frequency, and nocturia persist despite voiding, though voiding somewhat eases the discomfort [abdominal pain · lower abdominal pain · nocturia] - Voiding eases the pain somewhat but does not fully resolve it - Urgency, nocturia, or painful urination may occur, but incontinence is atypical [burning on passing urine · nocturia] - Diagnostic criteria require at least 6 weeks of symptoms with sterile urine cultures and no other explanation - Course is chronic with flares and remissions; anxiety, depression, and poor sleep are common as remission is rarely complete [anxiety · insomnia · low mood] - Pain is centered suprapubically but can extend to the perineum - Unusually large voided volumes or very infrequent voiding argue against the diagnosis - Sex hurts: painful intercourse in women, pain on ejaculation in men [painful intercourse] - The urge intensifies as the bladder fills and eases only briefly on passing urine, which is what drives the frequency - Frequency that does not settle on standard overactive bladder treatment should raise this diagnosis SIGNS - what you find (2) - Full neurological exam - tone, reflexes, power, sensation, cranial nerves - plus post-void residual volume is done in every suspected case - Pelvic exam in women checks for cervical tenderness, masses, prolapse, and adnexal abnormalities [genital prolapse] TESTS (10) - Baseline workup includes CBC, metabolic panel, glucose, HbA1c, microscopic urinalysis, urine culture, and STI screening - Culture is still worth sending even with a normal urinalysis, to catch low-grade bacteriuria that routine testing misses - AUA guidance does not require cystoscopy or urodynamic testing to make the diagnosis - A Hunner ulcer appears as a central scar within a patch of erythematous mucosa - Petechial bladder-wall bleeding (glomerulations) may be seen but is a non-specific finding - Bladder biopsy is reserved for cases where malignancy is a concern, not routine workup - Urodynamics has no finding specific to the diagnosis, though bladder capacity is often reduced to under 300 mL - Several urinary inflammatory markers (TNF-alpha, PGE2, interleukins, IP10, TAC, 8-OHdG) run high, though their clinical value is still unproven - Cystoscopy is used when bladder cancer, a foreign body, obstruction, stricture, or a stone is suspected - Unexplained blood in the urine, or a smoking history of 10 or more pack-years, triggers a formal hematuria workup IF NOT THIS - what else fits (4) - Chronic prostatitis overlaps heavily but lacks the urinary antiproliferative factor and bladder histology changes seen in IC - Pudendal neuralgia pain is more burning or electric, tied to sitting or bending rather than bladder fullness or diet - Overactive bladder that fails to respond to standard treatment should prompt reconsideration toward IC/BPS - Bladder cancer can mimic IC on both symptoms and cystoscopic appearance; found in about 1 in 20 patients biopsied in one series Source StatPearls "Interstitial Cystitis/Bladder Pain Syndrome" - disease-level clinical article Status traced to the source above Rx: Main treatment | H2 blocker - oral form not marketed in Egypt | Bladder coating agent - not registered in Egypt | Antihistamine and mast cell stabiliser MAIN TREATMENT - choose one 1. AMITRIPTYLINE [1st line] Adult 10-25 mg once daily at bedtime, titrate by 10-25 mg every 2-4 weeks up to 50-75 mg daily - long-term Peds Specialist pediatric urology referral 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. Why 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. Caution 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. Egypt TRYPTIZOL 10 MG 20 TABS. KAHIRA 10.00 EGP (0.50/unit) TRYPTIZOL 10 MG 60 TABS. KAHIRA 30.00 EGP (0.50/unit) GRANITYLLIN 25MG/5ML SYP. 120 ML GRAND PHARMA ... 5.00 EGP -> ? strength differs, ? different route - not oral solid ZINOTRAVAL 25MG/5ML SYP. 120 ML DEBEIKY > PHA... 10.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Interstitial Cystitis/Bladder Pain Syndrome - disease-level clinical article (interstitial-cystitis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - unexplained hematuria or significant smoking history requires evaluation to exclude bladder malignancy before/while treating as IC/BPS. 3. GABAPENTIN [2nd line] Adult 300 mg TID, titrated up to a maximum of 1,200 mg TID Peds Initial range: 10 to 15 mg/kg/day, given in three divided doses. Source Interstitial Cystitis (Bladder Pain Syndrome) - disease-level clinical article (interstitial-cystitis-clinical.txt) Why Oral neuromodulatory agent used for chronic neuropathic pain control in interstitial cystitis/bladder pain syndrome. Caution 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. Egypt GABA 100MG 10 CAPS. MULTI-APEX > ... 6.50 EGP (0.65/unit) PENTALIPSY 100 MG 10 CAPS. SAFE PHARMA 8.00 EGP (0.80/unit) EZAPENTIN 300MG 10 CAPS. MULTI-APEX 11.00 EGP (1.10/unit) GABAPENTIN 300 MG 30 CAPS. UNIPHARMA 96.00 EGP (3.20/unit) ANDOPENTENE XR 300 MG 20 F.C. TABS. ANDALOUS PHARMA 90.00 EGP (4.50/unit) CONVENTIN 600 MG 30 TABS. EVA PHARMA 171.00 EGP (5.70/unit) GABAVERONA 400 MG 30 H.G. CAPS. AVERROES PHARMA 156.00 EGP SAJALIPSY 400 MG 30 H.G. CAPS. SAJA PHARMACE... 156.00 EGP STABLENTIN 6MG/120ML SYRUP MEPACO 21.60 EGP -> ? strength differs, ? different route - not oral solid ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML EUROPEAN EGYPTIAN PHARM. IND. 37.00 EGP -> ? strength differs, ? different route - not oral solid H2 BLOCKER - ORAL FORM NOT MARKETED IN EGYPT 4. CIMETIDINE [2nd line] Adult 300-400 mg twice daily orally - long-term Peds Specialist use only Source AUA Guideline on Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome 2022 Why Oral cimetidine is not registered or marketed in Egypt; available only as IM/IV injection. Caution Cimetidine is an H2-receptor antagonist that reduces bladder mucosal mast cell activation. Inhibits hepatic CYP450 enzymes; inspect for drug interactions. Egypt CIMETIDINE 200MG/2ML I.M/I.V.AMP. EIPICO 14.40 EGP -> ? strength differs, ? different route - not oral solid BLADDER COATING AGENT - NOT REGISTERED IN EGYPT 5. PENTOSAN POLYSULFATE SODIUM [2nd line] Adult 100 mg three times daily taken with water 1 hour before or 2 hours after meals - long- term (3-6 months trial minimum) Peds Not indicated in children Source ELMIRON (pentosan polysulfate sodium) 100 mg capsules US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID f0ba651e-3d8a-11df-8fbe-119855d89593) Why Pentosan polysulfate sodium is not registered or marketed in Egypt. Caution 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. Egypt HEMOFLUSH 0.5% OINT. 30 GM EGPI > PHARMA... 6.50 EGP -> ? strength differs, ? different route - not oral solid HEMOCURE 0.5% GEL 20 GM EL NILE. 7.00 EGP -> ? strength differs, ? different route - not oral solid HEMOCLAR 0.5% CREAM 40 GM SANOFI > CHEM... 46.00 EGP -> ? strength differs, ? different route - not oral solid HEMOCLAR 0.5% CREAM 30 GM SANOFI > CHEM... 58.00 EGP -> ? strength differs, ? different route - not oral solid ANTIHISTAMINE AND MAST CELL STABILISER 6. HYDROXYZINE [2nd line] Adult 50 mg to 100 mg four times daily - long-term Peds Not a primary-care paediatric indication; refer. Source Interstitial Cystitis - disease-level clinical article (interstitial-cystitis- clinical.txt) Why 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. Caution 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. Egypt ATARAX 10 MG 20 TABS. CID 22.00 EGP (1.10/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)