Editing CUA: Interstitial Cystitis (2016) (section)

==== Intravesical ====
* '''<span style="color:#ff0000">Recommended (3): DMSO, heparin, lidocaine'''
*# '''<span style="color:#ff0000">Dimethylsulfoxide (DMSO)'''
*#* '''<span style="color:#ff0000">MOA: organic solvent with anti-inflammatory and analgesic properties'''
*#* Administered as a 50 mL solution of 50% DMSO with a dwell time of 30‒60 minutes, once weekly for 6 weeks. Monthly maintenance doses may be considered.
*#* Overall, favourable safety profile. Typical side effects include halitosis (garlic-like breath, as it is eliminated through the lungs) and potential flare-up after the first instillation, which usually improves after the second one.
*#* Theoretically may cause dissolution of collagen that could '''potentially cause bladder fibrosis if used on a long-term basis.'''
*# '''<span style="color:#ff0000">Heparin (alone or in combination)'''
*#* '''<span style="color:#ff0000">MOA: GAG analogue'''
*#* May be instilled intravesically with '''virtually no systemic absorption'''
*#* '''DMSO combined with heparin better than DMSO alone''' (further reduces and defers relapses)
*# '''<span style="color:#ff0000">Lidocaine'''
*#* '''<span style="color:#ff0000">MOA: local anesthetic'''
*#* Instillation on a daily or weekly basis of alkalinized lidocaine
*#* '''Option for short-term relief IC/BPS symptoms''', primarily bladder pain
* '''Options (hyaluronic acid, chondroitin sulfate, pentosan polysulfate, oxybutynin)''':
*# '''Hyaluronic acid'''
*#* MOA: May help replenish the GAG layer of the bladder.
*#* Efficacy unknown; 3 negative trials have been completed without published results
*# '''Chondroitin sulfate'''
*#* MOA: May help replenish the GAG layer of the bladder.
*#* Should not be used as monotherapy, but may be considered as part of multimodal therapy for IC/BPS.
*# '''Pentosan polysulfate (PPS, Elmiron)'''
*#* MOA: a weak analogue of heparin, may replenish the deficient GAG layer
*#* '''Intravesical PPS may be more effective than oral''' since only 1‒3% of oral PPS reaches the bladder.
*#* '''May be used alone or in combination with oral PPS'''
*# '''Oxybutynin'''
* '''Not recommended (resiniferatoxin, BCG):'''
*# Resiniferatoxin (RTX)
*#* A potent analogue of the chili pepper extract capsaicin; a neurotoxin that desensitizes C-fiber afferent neurons that transmit pain and, thus, could alleviate pain in IC/BPS.
*#* Based on conflicting Level 2 evidence and the adverse side effect profile, RTX is not recommended
*# Bacillus Calmette-Guerin (BCG)