East Region Formulary
NHS Scotland

Painful bladder syndrome

Treatment of painful bladder syndrome

Conservative management - dietary and lifestyle modification and simple analgesia.

Amitriptyline
Amitriptyline 10mg tablets

As directed by specialist; maintenance dose range between 50-150mg daily (lower doses in the elderly), can be reduced to 5mg depending on patient symptoms and tolerability.

Amitriptyline 25mg tablets

As directed by specialist; maintenance dose range between 50-150mg daily (lower doses in the elderly), can be reduced to 5mg depending on patient symptoms and tolerability.

Amitriptyline 50mg tablets

As directed by specialist; maintenance dose range between 50-150mg daily (lower doses in the elderly), can be reduced to 5mg depending on patient symptoms and tolerability.

Nortriptyline
Nortriptyline 10mg tablets

As directed by specialist.

Nortriptyline 25mg tablets

As directed by specialist.

Intravesical instillation – consult local guidelines. iAluRil bladder instillation (sodium hyaluronate 800mg / sodium chondroitin sulfate 1g intravesical solution 50ml pre-filled syringes).

Sodium hyaluronate + Chondroitin
iAluRil bladder instillation

As per specialist.

Intravesical instillation – consult local guidelines.

Sodium hyaluronate
Hyacyst 40mg bladder instillation pre-filled syringe

As per specialist.

Hyacyst 120mg bladder instillation pre-filled syringe

As per specialist.

Pentosan polysulfate sodium
Pentosan polysulfate sodium 100mg capsules

100mg three times a day, review treatment after 6 months and discontinue if no response.

Prescribing Notes:

  • Conservative management includes dietary and lifestyle modification, bladder retraining and simple analgesia.
  • For symptom relief consider oral amitriptyline, or if not tolerated consider nortriptyline as an alternative.
  • Pentosan polysulfate sodium (Elmiron) is approved for the treatment of adults with bladder pain syndrome characterised by either glomerulations or Hunner’s lesions in adults with moderate to severe pain, urgency and frequency of micturition.
  • MHRA/CHM advice (update Sept 2019) - Pentosan polysulfate sodium (Elmiron): rare risk of pigmentary maculopathy. Patients should have regular ophthalmic examinations during treatment, consider stopping treatment if pigmentary maculopathy develops. Patients should be advised to seek immediate medical attention if visual changes occur.
  • If conservative management and oral therapies are ineffective or not tolerated intravesical instillation may be considered.

History Notes

18/05/2022

East Region Formulary content agreed.