Elmiron

Elmiron is a semi-synthetically produced heparin-like macro molecular carbohydrate derivative, which chemically and structurally resembles glycosaminoglycans. It is available in 100 mg gelatin capsules.  

Indications

For the relief of bladder pain associated with IC (Interstitial Cystitis). The daily dose is 100 mg three times daily 1 hour before or two hours after meal. Usually a four to six months long therapy course is recommended before evaluating the effectiveness of the drug.  

Side effect (RARE AND MILD)

Nausea, diarrhea, vomiting, and dehydration, headaches, insomnia and emotional problems. Occasionally bleeding complications were noted.  

Clinical Studies

ELMIRON® was evaluated in clinical trials for the relief of pain in patients with Chronic Interstitial Cystitis (CIC). All patients met the NIH definition of IC based upon the results of cystoscopies, cytology and biopsy. One blinded, randomized, placebo controlled study evaluated 151 patients (145 women, 5 men, 1 unknown) with a mean age of 44 years (range 18 to 81). Approximately equal numbers of patients received either placebo or ELMIRON® 100 mg three times a day for 3 months. Clinical improvement in bladder pain was based upon the patient's own assessment. In this study, 28/74 (38%) of patients who received ELMIRON® and 13/74 (18%) of patients who received placebo, showed greater than 50% improvement in bladder pain (p=0.005).

Unfortunately, these numbers are not impressive enough to warrant wholesale dispensation of the drug to patients suffering from cystitis related bladder pains. Admittedly, some patients with IC can be incapacitated from pain and drugs offering relief are a free for all.

Patients with prostatitis can have a severe cystitis component and may need pain medication.  In my clinic Chlamydia is a frequent isolate in patients who have suspected or proven IC. Therefore, I always combine a several months long combination antibiotic course with whatever pain medication I may opt for.

I came to interpret IC as a combination of a single or multi bacterial bladder infection associated with a disproportionate local immune response.  Chlamydia, by virtue of its ability to live intracellular, including cells of the immune system, is singularly suitable to be the number one suspect to be able to interfere with all aspects of cell functions.  Clinical experience supports this notion since best treatment results are achieved when supportive remedies are combined with long-term combination antibiotic regimens possessing full spectrum against Chlamydia.