Therapeutic: agents for interstitial cystitis
Pharmacologic: heparin-like compounds
Management symptoms (bladder pain/discomfort) of chronic interstitial cystitis (IC).
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.
Adverse Reactions/Side Effects
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.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
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.
Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.
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).
Absorption: 6% absorbed following oral administrations.
Distribution: Distributes into uroepithelium of the genitourinary tract with less found in liver, spleen, lung, skin, periosteum, and bone marrow.
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.
Contraindicated in: Hypersensitivity.
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.
Drug-Drug: Concurrent use of coumarin anticoagulants, heparins, t-PA, streptokinase, high-dose aspirin, or NSAIDs may ↑ risk of bleeding.