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INTRODUCTION

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pentosan (pen-toe-san)

Elmiron

Classification

Therapeutic: agents for interstitial cystitis

Pharmacologic: heparin-like compounds

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Indications
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Management symptoms (bladder pain/discomfort) of chronic interstitial cystitis (IC).

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Action
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Adheres to uroepithelium, providing a protective barrier against irritating solutes in urine; has anticoagulant and fibrinolytic properties. Therapeutic Effects: ↓ pain and discomfort in chronic IC.

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Adverse Reactions/Side Effects
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CNS: dizziness, headache. EENT: epistaxis. GI: abdominal pain, diarrhea, dyspepsia, gum bleeding, ↑ liver enzymes, nausea, rectal bleeding. Derm: alopecia, ecchymosis, rash. Hemat: bleeding, ↑ bleeding time.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess for signs of bleeding and increased bleeding time, including bleeding gums, nosebleeds, and rectal bleeding. Notify physician if this drug causes increased bleeding.

  • Monitor signs of interstitial cystitis, including chronic pelvic pain, persistent urge to urinate, and painful sexual intercourse. Document whether this drug is successful in reducing these symptoms.

  • Assess dizziness that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

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Patient/Client-Related Instruction
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  • Instruct patient to report other bothersome side effects such as severe or prolonged headache, skin reactions (rash, bruising, hair loss), or GI problems (nausea, diarrhea, abdominal pain, indigestion).

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Pharmacokinetics
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Absorption: 6% absorbed following oral administrations.

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Distribution: Distributes into uroepithelium of the genitourinary tract with less found in liver, spleen, lung, skin, periosteum, and bone marrow.

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Metabolism and Excretion: Metabolized by saturable enzyme systems in liver, spleen, and kidney. Majority (58–84%) excreted in feces as unchanged (unabsorbed drug). Metabolites of absorbed drug are renally excreted; minimal renal excretion of unchanged drug.

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Half-life: 27 hr.

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TIME/ACTION PROFILE (↓ symptoms)

ROUTE ONSET PEAK DURATION
PO within 4 wk–6 mo unknown unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity.

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Use Cautiously in: Underlying coagulopathy, concurrent medications that ↑ bleeding risk, history of aneurysms. Thrombocytopenia, hemophilia, GI ulceration/bleeding, polyps, diverticula; History of heparin-induced thrombocytopenia; risk of bleeding may be ↑ hepatic insufficiency; OB: Use in pregnancy only if clearly needed; Lactation: Use cautiously in breast-feeding women; Pedi: safe and effective use in children <16 yr has not been established.

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Interactions
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Drug-Drug: Concurrent use of coumarin anticoagulants, heparins, t-PA, streptokinase, high-dose aspirin, or NSAIDs may ↑ risk of bleeding.

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Route/Dosage
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PO (Adults): 100 mg tid.

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