Amitriptyline, an old tricyclic antidepressant, has been shown to have significant efficacy in PBS/IC and numerous pain syndromes, presumably by increasing norepinephrine and serotonin levels in the brain and thus acting to potentiate the effects of the body's own endorphins. It is not unreasonable to postulate that a serotonin-norepinephrine receptor inhibitor like duloxetine might have similar analgesic effects in PBS/IC.

In a pilot observational study of 48 women with interstitial cystitis, van Ophoven and colleagues in Munster, Germany treated the patients prospectively with self-titration in an effort to achieve a target dose at week 4 of 40mg twice daily. The maximum dose was continued for a total of 5 subsequent weeks. The primary outcome measure was the patient overall assessment of change in condition (GRA). In this open label study, only 5 patients were identified as responders. Thirty-five percent of patients dropped out exclusively due to side effects. Nausea was present in all drop-outs. Thirty-one patients reached the target dose. Duloxetine did not result in statistically significant improvement of any symptom studied.

The authors conclude that treatment of PBS/IC with duloxetine did not result in significant symptom improvement. While drug administration was safe, tolerability of the drug was very poor. Nausea occurred at the starting dose of 20mg daily. As the efficacy of the drug in this open-label, observational study did not approach the benefit one usually expects from placebo, further trials of this drug for PBS/IC cannot be recommended at this time

van Ophoven A, Hertle L

Journal of Urology, 177(2):552-555, 2007

UroToday.com Painful Bladder Syndrome Section

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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