Interstitial Cystitis (IC) is a syndrome characterized by bladder and/or pelvic pain in the absence of any other identifiable cause, such as bacterial infection, bladder carcinoma, or cystitis induced by radiation or drug therapy. The etiology and pathophysiology of IC are not understood, which can make diagnosis and treatment difficult. The US National Institute of Diabetes and Digestive and Kidney Disease estimate that there are 70 cases per 100,000 in the US, the majority being women in their mid-40’s.

     There are many theories surrounding the cause of IC. One suggests that  IC may be induced by an allergy. Patients who exhibited symptoms of allergic disease, such as bronchial asthma and allergic rhinitis, had higher levels of histamine release on biopsy specimens.  Those that were treated with nasal and oral administration of a mast cell stabilizer (Cromolyn sodium) had an almost complete disappearance of urinary and other symptoms.

     It is also theorized that IC may be secondary to a defect in the surface of the mucous lining of the bladder. This abnormality may allow urine and toxins to penetrate into the deeper layers of the bladder wall, resulting in inflammation and the symptoms of IC.

     There is increasing evidence that extracellular adenoside triphosphate (ATP) may serve as a sensory neurotransmitter for pain. It is theorized that the epithelial cells lining the bladder release extracellular ATP which acts on receptors on the nerve endings and sends impulses via the spinal cord to pain centers in the brain.

     One of the most successful treatment options of IC is intravesical therapy. These therapies have the benefit of little systemic absorption and, therefore, fewer side effects. Some of the solutions used in intravesical therapy include DMSO, Oxybutin, Capsaicin, Lidocaine, antibiotics, and various combinations of medications. (These therapies must be compounded according to USP <797> sterile compounding guides.)

     Oral therapy includes antihistamines, tricyclic antidepressants, analgesics, NSAIDS, and heparin. L-arginine is a nutritional supplement that may decrease pain and urgency by inducing smooth muscle relaxation and immunological responses.

     Compounding pharmacists can play a vital role in assisting urologists in treating their patients with chronic interstitial cystitis. They can work together to provide safe, effective treatments that may ultimately improve the patients’ quality of life. For more information on how we can help with your patients suffering from interstitial cystitis, please contact us at This email address is being protected from spam bots, you need Javascript enabled to view it or call 716-484-1586.