Pain medication an effective option for interstitial cystitis, study shows

Amitriptyline (Elavil) is an effective treatment for interstitial cystitis, but it must be dosed carefully, and patients must be closely followed to help manage side effects, researchers reported yesterday.

The investigators, led by Arndt van Ophoven, MD, PhD, assistant professor of urology at the University Hospital, Muenster, Germany, randomized 50 patients who met the National Diabetes, Digestive and Kidney Diseases criteria for IC to treatment with amitriptyline or placebo. The patients remained on therapy for 4 months under a self-titration protocol that allowed for 25-mg dose increases at 1-week intervals to a maximum dose of 100 mg. The drug was taken once daily before bed.

Scores on the O'Leary-Sant Interstitial Cystitis Symptom & Problem Index decreased by 42% in patients on active therapy, compared with only 30% in patients on placebo (p

Overall, 92% of patients experienced anticholinergic side effects with amitriptyline, compared with 21% of patients in the placebo group. Two patients dropped out of the trial due to side effects, one from each arm of the study.

In a long-term open-label follow-up trial involving 94 IC patients, mean treatment duration was 16 months, and patients were followed for a mean of 19 months. Among these patients, 64% responded to treatment and 84% experienced anticholinergic side effects. Nearly half of patients reported excellent or good satisfaction with therapy, but 31% of patients dropped out of the trial, primarily due to non-response or side effects.

Amitriptyline deserves a trial in patients with IC, Dr. van Ophoven told Urology Times.

"It works nicely. However, inform patients about the possible side effects that can occur," he said. "If you decide to stay on the drug, do a meticulous follow-up with a yearly assessment of ECG, liver enzymes, and intraocular pressure."