Objective: To assess the efficacy of the oral prostaglandin analogue misoprostol in controlling the symptoms of interstitial cystitis in patients with refractory disease. Methods: Twenty-five patients were commenced on misoprostol 600 µg daily for 3 months. Patients who responded to therapy were offered treatment for a further 6 months. Assessment of the response was by a voiding log and an interstitial cystitis symptom score. Results: At 3 months, 14 patients (56%) had significantly improved, and after a further 6 months, 12 patients (48%) had a sustained response. The incidence of adverse drug effects was 64%. Most side effects were minimal, and the response rate in patients who were able to tolerate the drug was 87% at 3 months and 75% at 9 months. Conclusions: The oral prostaglandin analogue misoprostol is effective in treating the symptoms of interstitial cystitis. It is possible that prostaglandins have a cytoprotective action in the urinary bladder.

Gillenwater J, Wein A: Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, August 28–29. J Urol 1987;140:203–206.
Parsons CL, Lilly JD, Stein P: Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis). J Urol 1991;145:732–735.
Moskowitz MO, Byrne DS, Callahan HJ, Parsons CL, Valderrama E, Moldwin RM: Decreased expression of a glycoprotein component of bladder surface mucin (GP1) in interstitial cystitis [see comments]. J Urol 1994;151:343–345.
Thompson AC, Christmas TJ: Interstitial cystitis: An update. Br J Urol 1996;78:813–820.
Sant GR, LaRock DR: Standard intravesical therapies for interstitial cystitis. Urol Clin North Am 1994;21:73–83.
Bramble F, Morley R: Drug-induced cystitis: The need for vigilance. Br J Urol 1997;79:3–7.
Ahmed M, Davidson O: Severe cystitis associated with tiaprofenic acid. Br Med J 1991;303:1376.
Henley MJ, Harris D, Bishop MC: Cystitis associated with tiaprofenic acid: A survey of British and Irish urologists. Br J Urol 1997;79:585–587.
Ballinger A: Cytoprotection with misoprostol: Use in the treatment and prevention of ulcers. Dig Dis 1994;12:37–45.
Jeremy J, Mikhailidis D, Dandona P: The rat urinary bladder produces prostacyclin as well as other prostaglandins. Prostaglandins Leukot Med 1984;16:235.
Jeremy J, Mikhailidis D, Dandona P: Cigarette smoke extracts inhibit prostacyclin synthesis by the rat urinary bladder. Br J Cancer 1985;51:837–842.
Mohuiddon J, Prentice H, Schev S: Treatment of cyclophosphamide-induced cystitis with prostaglandin E2. Ann Intern Med 1985;101:142.
Trigg M, O’Reilly J, Ruhelhart S: Prostaglandin E1 bladder instillations to control severe haemorrhagic cystitis. J Urol 1990;143:92–94.
Levine L, Jarrard D: Treatment of cyclophosphamide-induced haemorrhagic cystitis with intravesical carboprost tromethamine. J Urol 1993;149:719–723.
El-Gendi M, Nassar S, Toppozada M, Abdel-Raheem F: Pharmacotherapeutics of prostaglandin E2 and 15(s) 15-methyl prostaglandin F2 in chronic schistosomal bladder ulcer: A clinicoendoscopic study. Prostaglandins 1982;24:97–104.
O’Leary MP, Sant G, Whitmore C, Fowler FJ, Spolarich-Kroll J: The IC symptom index (abstract). Proc Am Urol Assoc 1996;155:439.
Parsons CL, Benson G, Childs SJ, Hanno P, Sant GR, Webster G: A quantitatively controlled method to study prospectively interstitial cystitis and demonstrate the efficacy of pentosanpolysulfate. J Urol 1993;150:845–848.
Jeremy J, Tsang V, Mikhailidis D, Rogers H, Morgan R, Dandona P: Eicosanoid synthesis by human urinary bladder mucosa: Pathological implications. Br J Urol 1987;59:36–39.
Mikhailidis D, Jeremy J, Dandona P: Urinary bladder prostanoids: Their synthesis, function and possible role in the pathogenesis and treatment of disease. J Urol 1987;137:577.
Green R, MacAndrew V, Lloyd M: Stimulation of glycosaminoglycan synthesis by cyclic AMP. Biochem Biophys Res Commun 1982;107:232.
Khalaf I, Lehoux J, Elshawarwardy L, Elhilali M: Release of prostaglandins into pelvic venous blood of dog in response to vesical distension and pelvic nerve stimulation. Invest Urol 1979;17:244.
Farcas A, Alajem D, Dekel S, Binderman I: Urinary prostaglandin E2 in acute bacterial cystitis. J Urol 1980;124:455.
Downie J, Karmazyn M: Mechanical trauma to the bladder epithelium liberates prostanoids which modulate neurotransmission in rabbit detrusor muscle. J Pharmacol Exp Ther 1984;230:445.
Gary K, Engelmann E, Johnson E, Fishman I: Evaluation of misoprostol cytoprotection of the bladder with cyclophosphamide (Cytoxan) therapy. J Urol 1986;136:497–500.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.