Pentosan polysulfate
Semi-synthetic polysulfated polysaccharide for interstitial cystitis.
What it is
Pentosan polysulfate sodium (Elmiron) is a semi-synthetic polysulfated polysaccharide chemically related to heparin. It was FDA-approved in 1996 for relief of bladder pain and discomfort associated with interstitial cystitis. It is the only oral medication specifically approved for interstitial cystitis.
Mechanism of action
The exact mechanism is not fully characterized but is thought to involve restoration of the bladder’s glycosaminoglycan (GAG) layer, which is hypothesized to be deficient in interstitial cystitis. After oral administration, pentosan polysulfate is partially excreted in urine where it may bind to bladder mucosa and reduce permeability to irritants.
Approved indications
Interstitial cystitis (IC), also called bladder pain syndrome, particularly when symptoms have not responded adequately to behavioral and dietary interventions.
Why this is out of scope at The Tide
Interstitial cystitis is appropriately managed by urology, urogynecology, or pain medicine specialists with experience in this complex condition. Treatment typically involves a combination of behavioral interventions, dietary modifications, intravesical therapies, and oral medications coordinated by the appropriate specialist.
Additionally, pentosan polysulfate has been associated with retinal toxicity (pigmentary maculopathy) with long-term use — this requires ophthalmologic monitoring that is most appropriately coordinated with the prescribing specialist.
Where to learn more
Patients with interstitial cystitis should work with urology, urogynecology, or pain medicine. The Interstitial Cystitis Association is also a good educational resource.