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Bladder Pain & IC/BPS Pharmacotherapy

Pharmacotherapy for interstitial cystitis / bladder pain syndrome (IC/BPS) is individualized. The AUA 2022 guideline removed numbered treatment tiers: oral drugs and bladder instillations can be combined with appropriate behavioral and physical therapies, while lesion-directed treatment matters for Hunner lesions. Evidence for many drugs remains uncertain.[1]

The CUA 2025 update conditionally recommends against oral pentosan polysulfate (PPS) and cannot identify a preferred intravesical agent or cocktail. The oral hub explains the PPS benefit–risk discussion and retinal surveillance.[2]

For pelvic-floor myalgia adjuncts (gabapentinoids, TCAs, vaginal diazepam) see Neuropathic & Pelvic Pain. For chronic pelvic pain frameworks see IC/PBS.

  • Oral IC/BPS AgentsAmitriptyline, cimetidine, hydroxyzine, PPS and selected cyclosporine use. PPS retinal toxicity is a label warning; screening and treatment continuation require individual assessment.
  • Intravesical AgentsDMSO (Rimso-50), heparin/lidocaine and GAG agents, with exact study regimens distinguished from prescribing protocols. Comparative evidence, systemic absorption cautions and off-label botulinum toxin for selected refractory cases.

References​

1. Clemens JQ, Erickson DR, Varela NP, Lai HH. "Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome." J Urol. 2022;208(1):34–42. doi:10.1097/JU.0000000000002756

2. Doiron RC, Tadayon B, Violette PD, et al. "2025 Canadian Urological Association Guideline: Selected treatment recommendations for interstitial cystitis/bladder pain syndrome." Can Urol Assoc J. 2025;19(4):90–103. doi:10.5489/cuaj.9182