Bladder Pain & IC/BPS Pharmacotherapy

Pharmacotherapy for interstitial cystitis / bladder pain syndrome (IC/BPS) and related bladder-pain phenotypes. The AUA/CUA/SUFU 2022 IC/BPS guideline structures management as a stepwise progression: behavioral and dietary modification first, then oral therapy (amitriptyline, pentosan polysulfate, hydroxyzine, cimetidine), then intravesical instillation (DMSO, heparin, lidocaine, hyaluronic acid, chondroitin sulfate), reserving cyclosporine, neuromodulation, and major surgery for refractory disease. Most pharmacotherapy is modestly effective in heterogeneous trials; phenotyping (Hunner-lesion vs non-Hunner) and identifying pelvic-floor myalgia are the dominant determinants of which agents actually help.

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

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• Oral IC/BPS AgentsPentosan polysulfate sodium (Elmiron) — the only FDA-approved oral IC drug — with the PPS-maculopathy boxed warning and annual ophthalmologic-screening rule. Amitriptyline as the most effective oral systemic option. Hydroxyzine, cimetidine, and the broader oral repertoire.
• Intravesical AgentsDMSO (Rimso-50, FDA-labeled), the heparin / lidocaine / bicarbonate "rescue cocktail," hyaluronic acid and chondroitin sulfate GAG-replenishment agents (HA, CS, HA+CS), Cervigni equivalent-to-DMSO data, and the off-label intratrigonal botulinum toxin pathway as a bridge to neuromodulation.