Urology - Other agents

Interstitial cystitis
pentosan polysulfate (Elmiron ®)
Urinary retention
Bethanecol (Urecholine ® )
Hemorrhagic Cystitis
Alum irrigation	Treatment of Hemorrhagic Cystitis

Interstitial cystitis

pentosan polysulfate (Elmiron ®)

CLINICAL PHARMACOLOGY
General:
Pentosan polysulfate sodium is a low molecular weight heparin-like compound. It has anticoagulant and fibrinolytic effects. The mechanism of action of pentosan polysulfate sodium in interstitial cystitis is not known.

INDICATIONS AND USAGE
ELMIRON® (pentosan polysulfate sodium) is indicated for the relief of bladder pain or discomfort associated with interstitial cystitis.

CONTRAINDICATIONS
ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients.

Adults: Oral: 100 mg 3 times/day taken with water 1 hour before or 2 hours after meals
Patients should be evaluated at 3 months and may be continued an additional 3 months if there has been no improvement and if there are no therapy-limiting side effects. The risks and benefits of continued use beyond 6 months in patients who have not responded is not yet known .

Administration
Should be administered with water 1 hour before or 2 hours after meals.

SUPPLIED:
Capsule: 100 mg

Urinary retention

Bethanecol (Urecholine ® )

Drug Category: Cholinergic Agonist. Indication: Nonobstructive urinary retention and retention due to neurogenic bladder.

Dosing (Adults):
Urinary retention, neurogenic bladder, and/or bladder atony:
Oral: Initial: 10-50 mg 2-4 times/day (some patients may require dosages of 50-100 mg 4 times/day). To determine effective dose, may initiate at a dose of 5-10 mg, with additional doses of 5-10 mg hourly until an effective cumulative dose is reached. Cholinergic effects at higher oral dosages may be cumulative.
SubQ: Initial: 2.575 mg, may repeat in 15-30 minutes (maximum cumulative initial dose: 10.3 mg); subsequent doses may be given 3-4 times daily as needed (some patients may require more frequent dosing at 2.5- to 3-hour intervals).
Chronic neurogenic atony may require doses of 7.5-10 mg every 4 hours.

Gastroesophageal reflux (unlabeled): Oral: 25 mg 4 times/day.

Supplied: [Tablet: 5 mg, 10 mg, 25 mg, 50 mg]

Hemorrhagic Cystitis

Alum irrigation

An astringent that induces hemostasis by precipitating protein over the bleeding surface. Since it has low cell permeability, its action is limited to the cell surface and interstitial spaces.
Usual concentration: 1 percent alum bladder irrigation (base solution usually saline). Reserved for moderate to severe hematuria/bladder hemorrhage. Average instillation rate: 250-300 ml/hour. In mild cases, saline continuous bladder irrigation or suprahydration may be used.

Treatment of Hemorrhagic Cystitis

Disclaimer

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David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.