Open Access

ARTICLE

Heparin and alkalinized lidocaine versus alkalinized lidocaine for treatment of interstitial cystitis symptoms

C. Lowell Parsons¹, James A. Koziol², Jeffrey G. Proctor³, Paul Zupkas¹, Sulabha Argade¹

1 Department of Urology, UC San Diego Health System, San Diego, California, USA
2 The Scripps Research Institute, La Jolla, California, USA
3 Georgia Urology, Atlanta, Georgia, USA
Address correspondence to Dr. C. Lowell Parsons, Department of Urology, UC San Diego Health System, 200 West Arbor Dr. #8897, San Diego, CA 92103-8897 USA

Canadian Journal of Urology 2015, 22(2), 7739-7744.

Abstract

Introduction: Interstitial cystitis (IC), sometimes referred to as IC/bladder pain syndrome, is a substantial health care problem. Once considered a rare, orphan disease, it is now believed to be relatively common. This pilot study was undertaken to determine if the combination of heparin and alkalinized lidocaine (heparin-lidocaine) was more efficacious than alkalinized lidocaine at relieving pain and urgency symptoms associated with IC and also capable of yielding higher lidocaine absorption.
Materials and methods: A single blind study was conducted on 14 IC patients with a heparin-lidocaine combination versus alkalinized lidocaine instilled intravesically. In a separate study serum lidocaine levels for heparin-alkalinized lidocaine combination versus USP lidocaine only were determined by high performance liquid chromatography.
Results: Alkalinized lidocaine and heparin have been reported to provide relief from pain and urgency symptoms associated with IC. The heparin-lidocaine combination significantly reduced the % of bladder pain (38% versus 13%, p = 0.029) and urgency (42% versus 8% p = 0.003) compared to lidocaine. In addition the GAR was significantly better for the heparin-lidocaine combination at both 1 hr % improved (77% versus 50%, p = 0.04) and 24 hrs (57% versus 23%, p = 0.002) after study drug treatment. Serum lidocaine levels for the heparin-lidocaine combination were significantly higher compared to USP lidocaine (unalkalinized). The mean ± SEM was 0.45 ± 0.09 µg/mL and 0.20 ± 0.05 µg/mL, respectively (p = 0.019).
Conclusions: In this pilot study the heparin-lidocaine combination results in significantly better relief of IC symptoms compared to alkalinized lidocaine and the combination yields higher lidocaine absorption than USP lidocaine.

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