Effect of Amitriptyline on Symptoms in Treatment Naïve Patients With Interstitial Cystitis/Painful Bladder Syndrome

Abstract

Background-Amitriptyline is frequently used to treat patients with IC/PBS. The evidence to support this practice is derived mainly from a small single site clinical trial and case reports.

CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome

“…78,79 Two RCTs have demonstrated a benefit of amitriptyline over placebo. 57,80 Van Ophoven et al 80 reported a statistically significant improvement in O'Leary-Sant IC symptom and problem index scores from baseline in patients treated with amitriptyline vs. placebo (p=0.05). Overall, 63% vs. 4% of the treatment group vs. placebo group were considered significantly improved at four months followup.…”

“…Significant improvement in 45-50% of patients may be expected with only advice and support, as demonstrated in two well-designed, randomized trials. 57,58 Bosch et al have developed a practical IC/BPS standard advice checklist to insure all healthcare topics are discussed with the patient. 58 Up to 90% of patients have exacerbations of their symptoms after ingesting certain foods or drinks.…”

“…Side effects were common, with a reported rate of 92% vs. 21% in the treatment vs. placebo groups, respectively. Most recently, Foster et al 57 reported a statistically significant improvement in global response assessment in treatment-naïve patients treated with amitriptyline vs. placebo, but only at a dose Intravesical oxybutynin 10 mg oxybutynin (crushed tablets) diluted in 500 mL NS instilled until first sensation; weekly for six weeks, then monthly for three months Hydrodistension (HD) Therapeutic HD under spinal or general anesthesia, where the bladder is filled with NS by gravity drainage at a pressure of 80 cm H2O to its capacity and distension is maintained for two to no more than 10 minutes; the bladder is drained at the end and capacity is measured Triamcinolone (steroid) injection for Hunner's lesions 1 mL vial of triamcinolone (40 mg/mL) diluted in 9 mL NS (total 10mL), to be injected in aliquots of 1 mL Botulinum toxin A 100U suburothelial injection ± trigone bid: twice daily; IC/BPS: interstitial cystitis/ bladder pain syndrome; NaHCO3: sodium bicarbonate; NS: normal saline; po: orally; qhs: every night at bedtime; tid: three times daily.…”

Bladder dysfunction in peripheral neuropathies

“…73 They function to increase norepinephrine and serotonin levels and exhibit anticholinergic and direct muscle relaxant effects on the urinary bladder. 73,74 HEREDITARY PERIPHERAL NEUROPATHIES Hereditary peripheral neuropathies are genetically and phenotypically heterogeneous disorders. Charcot-Marie-Tooth (CMT) disease is the most common inherited peripheral neuropathy.…”

Management of Bladder Pain Syndrome

“…A systematic review 47 of two randomised controlled trials (RCTs) 48,49 that included a total of 281 patients who were treated with increasing titrated doses of amitriptyline between 10 mg and 100 mg over a 4-month period showed trends in improvement in urinary urgency, frequency and pain scores in both trials compared with nontreated patients. However, these were only statistically significant in the smaller study of 48 patients.…”