Pentosan polysulfate sodium (Elmiron) adheres to the bladder wall and protects the bladder mucosa from irritating substances in the urine. It is used in the symptomatic treatment of patients with interstitial cystitis.

Pentosan polysulfate sodium Uses:

• Interstitial cystitis:

  • It is indicated for the relief of bladder pain or discomfort caused by interstitial cystitis.

Pentosan polysulfate sodium (Elmiron) Dose in Adults

Pentosan polysulfate sodium (Elmiron) Dose in the treatment of Interstitial cystitis:

• 100 mg orally three times a day.

Note:

• Evaluate patients after three months and the treatment duration may be extended for an additional three months if little or no improvement has been observed and side effects are not limiting further treatment continuation.
• Treatment beyond six months has not been evaluated in non-responders.

Dose in Children:

Refer to adults dosing.

Pentosan polysulfate sodium (Elmiron) Pregnancy Category: B

• However, it has not been tested in human pregnancies. In animal reproduction studies however, adverse pregnancy outcomes have not been observed.
• If indicated, it should not be used during pregnancy.
• It doesn't cross the blood-brain border.

Use during breastfeeding:

• It is unknown if the drug is found in breast milk.
• It is recommended that you use it with caution if you are lactating.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling. It has not been studied in patients with kidney disease.

Dose in Liver Disease:

• There are no dosage adjustments provided in the manufacturer's labeling.
• It has not been studied in patients with liver disease, however, it should be used with caution in patients with the liver disease since liver disease may affect the pharmacokinetics of the drug.

Side Effects of Pentosan polysulfate sodium (Elmiron):

• Central Nervous System:

  • Headache
  • Dizziness

• Dermatologic:

  • Alopecia
  • Skin Rash

• Gastrointestinal:

  • Diarrhea
  • Nausea
  • Abdominal Pain
  • Dyspepsia

• Hematologic & Oncologic:

  • Rectal Hemorrhage

• Hepatic:

  • Abnormal Hepatic Function Tests

Contraindications to Pentosan polysulfate sodium (Elmiron):

Allergy reactions to pentosan, polysulfate salt sodium, or any component of formulation.

Warnings and precautions

• Bleeding

  • It is a heparinoid, a low-molecular weight heparin-like substance.
  • This compound has anticoagulant as well as fibrinolytic qualities. 
  • It can cause bleeding complications like epistaxis and gum bleeding.
  • Patients with underlying coagulopathy, patients who are taking anticoagulants such as heparin or warfarin, NSAIDs or high dose aspirin or thrombolytics or who have undergone invasive procedures, are at high risk of bleeding.

• Aneurysm:

  • Before treatment can be initiated, patients with aneurysms should be carefully evaluated.

• Bleeding disorders:

  • Before treatment can be initiated, patients should be examined for bleeding disorders such as hemophilia or thrombocytopenia.

• Gastrointestinal Disease:

  • Before treatment can be initiated, patients should be examined for gastrointestinal conditions such as gastrointestinal ulceration and polyps.

• Heparin-induced hemocytopenia

  • Patients with a history heparin-induced hemocytopenia should not use it.

• Hepatic impairment

  • Patients suffering from liver impairment should be cautious when using it.

Pentosan polysulfate sodium: Drug Interaction

Monitoring parameters:

None mentioned.

How to administer Pentosan polysulfate sodium (Elmiron)?

It is administered on an empty stomach, one hour before or two hours after meals.

Mechanism of action of Pentosan polysulfate sodium (Elmiron):

• It sticks to the bladder wall, acts as a buffer, and protects the urinary bladder's mucosa. 
• It protects bladder tissue against substances in urine which could irritate it.
• Although it is primarily a low-molecular-weight heparinoid of low molecular weight, its mechanism of action in protecting the bladder wall is unknown.

Absorption:

• 6%

Metabolism:

• It is partially desulfated in the liver and spleen.
• Partial depolymerization takes place in the renal parenchyma. It is saturable

Half-life elimination:

• 20-27 hours

Time to peak serum concentration:

• 2 hours (range: 0.6-120 hours)

Excretion:

• Feces (58% to 84%, as unchanged drug);
• urine (6%, primarily as metabolites)

International Brand Names of Pentosan polysulfate sodium:

• Elmiron
• Comfora
• Fibrase
• Fibrezym
• Fibrocide
• Hemoclar
• Penpol
• Pentotitis
• Polyanion
• SP54
• Tavan-SP
• Thrombocid
• Trombotsyd

Pentosan polysulfate sodium Brand Names in Pakistan:

No Brands Available in Pakistan.