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Antihistamines Some patients report a decrease in IC symptoms using other antihistamines or medicines with antihistamine properties. Though the most widely used antihistamine to treat IC is hydroxyzine, some people with IC find relieve from Claritin, Benadryl, and Singulair. Dosage & Treatment Plan Most patients start with a 10 to 25 milligram (mg) dosage of Atarax, Vistaril or their generic equivalent at bedtime every night for 1 week, and progress to 50 mg every night the second week. Ideally, within one month the dosage is increased to 75 mg, 50 mg taken at night and 25 mg taken during the day. Benefits of hydroxyzine may be seen within a few weeks to two months after initiating therapy. To decrease the sedating side effects, some patients start hydroxyzine therapy at a 10 mg dosage, available with Atarax or in the liquid form, and work their way up, gradually, to a maximum dosage of 50 to 75 mg. After one year some patients are able to decrease their dosage by one-half. Others report that upon reducing their dosage, symptoms will return within a few days. Potential Side Effects Side effects include sedation, dry mouth, and increased depression in patients diagnosed with concurrent depression. Hydroxyzine A mild anti-anxiety drug, hydroxyzine is available in two oral forms: Hydroxyzine pamoate (Vistaril) Hydroxyzine hydrochloride (Atarax) Hydroxyzine affects mast cell degranulation, which is thought to play a part in some IC patients’ symptoms, especially those who have a history of allergies, migraines and irritable bowel syndrome. Hydroxyzine has been shown to improve these conditions, as well as IC. Hydroxyzine has been found to decrease: Nocturia (night time voiding) Daytime frequency Pain (burning, pressure, painful intercourse) Hydroxyzine pamoate has a slightly higher absorption rate. Hydroxyzine-HCL is a liquid form available for patients allergic to fillers or dyes used in the capsules or pills. Interstitial Cystitis Association © 2009 www.ichelp.org RFZ/ Updated Jul 2009 Printed Nov 2009 Take this medicine early in the evening initially to avoid excessive morning drowsiness. Most patients report that daytime drowsiness disappears within four to five days after beginning hydroxyzine therapy. Some patients report that with each dosage increase, the drowsiness period is shorter and not as intense. Pregnancy & Warnings Animal studies have found that fetal abnormalities occur at doses ten times higher than given to humans. It is not recommended that hydroxyzine be used if pregnant or nursing. Hydroxyzine is contraindicated for use in epileptic patients. Anti-seizure Medicines Originally developed as an anti-seizure medicine, gabapentin (neurontin) is also used to treat nerve-related pain. Some types of IC pain may to be generated by nerve endings and the central nervous system. A few small studies showed that gabapentin may improve symptoms in some IC patients. Histamine Blockers Most antihistamines prescribed for allergy and IC are called "H1" blockers. When histamines bind to the histamine receptors on cells, that produces an allergic reaction. The H1 receptors aren’t the only ones that histamines go to, however. They can also bind to H2 receptors, and drugs that block these receptors can also be helpful in calming allergic reactions. H2 blockers include Cimetidine (Tagamet) Ranitidine (Zantac) Nizatidine (Axid) Famotidine (Pepcid) By blocking these H2 receptors in the gut, these medicines reduce stomach acid secretions and, thus, stomach pain. Studies with one of these H2 blockers, cimetidine, showed it reduced bladder pain as well, maybe because of the histamine-blocking action. But why it works in IC really isn’t so clear. In two small studies (one with 9 and one with 14 patients), Tagamet reduced bladder pain for 40 to 60 percent of the IC patients. In Japan, Suplatast tosilate, also known as IPD-1151T and available is indicated for IC, as well as asthma and allergies. This medicine acts somewhat earlier in the allergic process than histamine or leukotriene blockers do by affecting IgE. Suplatast tosilate helps suppress the production of IgE. It also helps to block production of cytokines and suppresses allergy-related eosinophils. This medicine remains under investigation in the US. potential side-effects -- some serious -- so a cautionary approach is necessary and more research is needed. Mycophenolate (CellCept) works in the body by reducing the immune system's ability to produce certain reactions that can cause inflammation, pain, and discomfort. Mycophenolate mofetil is approved by the US Food and Drug Administration (FDA) for use in patients who have had an organ transplant. However, a large national study sponsored by the National Institutes of Health (NIH) did not find mycophenolate mofetil to be effective for IC and the study was ultimately canceled. Leukotriene Inhibitors Leukotrienes which are substances produced by some immune system cells and mast cells, promote inflammation. Drugs that block leukotrienes are fairly new and are being used in the treatment of asthma and allergy. They include the prescription medicines: Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Zyflo) Some studies have implicated leukotrienes in inflammation of the bladder in IC. The receptors have been found in the bladder muscle in IC patients. A study of 10 IC patients in Denmark who took Singulair for three months showed significant reductions in frequency and pain. Tagamet, Zantac, Axid, and Pepcid are available over the counter. Immunosuppresants Cyclosporine, an immunosuppressive drug used in organ transplantation, is also a treatment for several autoimmune disorders with good results. Because IC may have an autoimmune component, this medicine is being studied as a possible IC treatment. So far the results of testing in humans have been encouraging, but the drug does have many Interstitial Cystitis Association © 2009 www.ichelp.org RFZ/ Updated Jul 2009 Printed Nov 2009 The ICA provides advocacy, research funding, and education to ensure early diagnosis and optimal care with dignity for people affected by IC. Your donation dollars also enable the ICA to continue to fund new IC research projects, as well as work closely with Congress to ensure ongoing IC-specific research funding at the federal level. www.ichelp.org [email protected]