ELSEVIER HYDROXYZlNE THERAPY FOR INTERSTITIAL CYSTITIS THEOHARIS C. THEOHARIDES AND GRANNUM R. SANT ABSTRACT Objectives. To determine the usefulness of oral hydroxyzine for the treatment of symptomatic interstitial cystitis. Methods. This study was an open-label, nonconsecutive case series of patients treated by their local phy- sicians, in consultation with the authors. A case-report form using visual analog scales was used to assess outcomes. Results. Out of 140 patients, 90 (65%) returned the case-report forms. A 40% reduction in symptom scores was reported. This rose to 55% in patients with a history of allergies. Conclusions. Hydroxyzine is a useful drug for the symptomatic treatment of IC, especially in patients with documented allergies and/or evidence of bladder mast cell activation. UROLOGY 49(Suppl 5A): 108-l 10, 1997. 01997 by Elsevier Science Inc. All rights reserved. I nterstitial cystitis (IC) is a bladder disorder characterized by frequency, nocturia, and ur- gency, as well as dyspareunia and suprapubic pain and pressure.’ Although the cause(s) of IC is un- known, increased numbers of activated mast cells located adjacent to nerve endings have been re- ported in a subset of IC patients2 Many IC patients also have a history of allergies, migraines, and ir- ritable bowel syndrome.3 The treatment of IC is frequently unsatisfactory due to the lack of any definitive theory as to its etiology and pathogenesis. Elevated histamine, methylhistamine, and tryptase levels in the urine of IC patients suggest a role for mast cell activation in pathogenesis. 4-6 The histamine-l (H,) receptor antagonist tripelennamine hydrochloride (Pyri- benzamine, Ciba-Geigy, Summit, NJ>,7 has been used in the past without much success. Prelimi- nary findings from a pilot, open-label study indi- cate that IC patients who were prescribed hydro- xyzine for more than 3 months had substantial symptom improvement.8 From the Departments of Pharmacology / Experimentul Theru- peutics and Zntemal Medicine, and Urology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts Reprint requests: T.C. Theoharides, M.D., Ph.D., Department of Phannncology and Experimental Therapeutics, Tufts Univer- sity School of Medicine, 136 Harrison Ave., Boston, MA 0211 I COPYRIGHT 1997 BY ELSEVIER SCIENCE INC 108 ALL RIGHTS RESERVED METHODS AND RESULTS A total of 140 patients from throughout the US who fit the National Institutes of Health diagnostic criteria have had their local physicians prescribe hydroxyzine. The majority of these patients had contacted one of the authors (TCT) by telephone or writing regarding hydroxyzine treatment after publication of the initial report.* The patients and their local physicians were advised that hydroxy- zine is not approved for IC, it should not be pre- scribed for any patient who is pregnant or contem- plating pregnancy, and it should be taken with caution in clinically depressed patients. It was also stressed that hydroxyzine is sedating, at least tem- porarily, and that concurrent administration of hy- droxyzine and tricyclic antidepressants or benzo- diazepines could increase sedation, Patients were provided with a standardized case report form in order to score the severity of their symptoms using a 10 cm (1 = best, 10 = worst) visual analog scale for the following symptoms: overall response, fre- quency, nocturia, burning/pain, pressure, and painful intercourse. Oral hydroxyzine was prescribed as hydroxyzine hydrochloride (Atarax, Pfizer, New York, NY) or hydroxyzine pamoate (Vistaril, Pfizer) or their re- spective generic formulations, by the physicians responsible for the care of the patients. Patients who were allergic or sensitive to the fillers or dyes used in the pill or capsule were prescribed hydro- xyzine-HC1 elixir instead. Patients started with 25 0090-4295/97/$17.00 PI1 SOO90-4295(97)00182-9