Pentosan polysulfate sodium (PPS) is a semi-synthetic medication derived from beechwood hemicellulose, a complex carbohydrate. It is commonly used as a medication in both veterinary and human medicine, primarily for its anticoagulant and anti-inflammatory properties.

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:

• For treating interstitial cystitis, the typical dose of pentosan polysulfate sodium is 100 milligrams taken three times a day by mouth.
• After three months, patients should be checked again by their doctor.
• If there hasn't been any improvement and there are no bad side effects from the medicine, the treatment can continue for another three months.
• However, it's not clear what the risks and benefits are of using it for more than six months if the patient hasn't gotten better.

Dose in Children:

Refer to adults dosing.

Pentosan polysulfate sodium (Elmiron) Pregnancy Category: B

• In animal studies, no harmful effects were seen on pregnancy, but there were some concerns about limb development in early animal studies.
• There isn't enough information from studies involving pregnant women to know for sure if it's safe during pregnancy.
• If a doctor decides it's necessary, it should be used cautiously during pregnancy.
• From the limited information available, it doesn't seem like pentosan polysulfate crosses the placenta to affect the baby.

Use during breastfeeding:

• It's uncertain whether pentosan polysulfate sodium passes into breast milk.
• The manufacturer advises caution when giving this medication to breastfeeding women.

Dose in Kidney Disease:

• The manufacturer's instructions do not include any adjustments to the dosage of pentosan polysulfate sodium for people with kidney problems.
• This means there haven't been specific studies to determine if the dosage needs to be changed for those with kidney impairment.

Dose in Liver Disease:

• The manufacturer's instructions don't mention any changes to the dosage of pentosan polysulfate sodium for people with liver problems.
• However, liver impairment could potentially affect how the medication is processed in the body.
• So, it's recommended to be cautious when using this medication in such cases.

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):

If someone has a hypersensitivity (allergic) reaction to pentosan polysulfate sodium, or to any related compounds like LMWHs (low molecular weight heparins) or heparin, or any other component of the medication, they should not use it.

Warnings and precautions

Bleeding

• Pentosan polysulfate works similarly to heparin, which can thin the blood and increase the risk of bleeding.
• Watch out for signs like easy bruising, nosebleeds, or bleeding gums.
• Patients who are about to undergo surgery or those with conditions that increase bleeding risk should be assessed before starting treatment.

Aneurysm:

• Before starting treatment, it's important to carefully assess patients with aneurysms to avoid potential complications.

Bleeding disorders:

• Patients with conditions like hemophilia or low platelet counts should be evaluated before starting treatment to avoid worsening bleeding issues.

Gastrointestinal Disease:

• Patients with gastrointestinal problems such as ulcers, polyps, or diverticula should be evaluated before starting treatment to avoid aggravating these conditions.

Heparin-induced hemocytopenia

• Patients with a history of heparin-induced thrombocytopenia should use this medication cautiously.

Hepatic impairment

• Patients with liver problems should use this medication with caution, as it could affect how the drug is processed in the body.

Pentosan polysulfate sodium: Drug Interaction

Monitoring parameters:

None mentioned.

How to administer Pentosan polysulfate sodium (Elmiron)?

• Take pentosan polysulfate sodium with water, either one hour before eating or two hours after meals. This helps the medication work effectively.

Mechanism of action of Pentosan polysulfate sodium (Elmiron):

• While pentosan polysulfate sodium shares similarities with low-molecular-weight heparins, it's not clear if these similarities are involved in how it treats interstitial cystitis.
• Instead, the drug seems to stick to the lining of the bladder, where it might act as a protective barrier, shielding the tissues from irritating substances found in urine.

Absorption:

• About 6% of the medication is absorbed into the body.

Metabolism:

• It undergoes partial desulfation in the liver and spleen, as well as partial depolymerization in the renal parenchyma.
• This process is saturable, meaning it has limits.

Half-life Elimination:

• Pentosan polysulfate sodium has an elimination half-life of 20-27 hours, meaning it takes this amount of time for half of the drug to leave the body.

Time to Peak Serum Levels:

• It takes around 2 hours for the drug to reach its highest concentration in the blood.
• However, this can vary widely, with a range of 0.6 to 120 hours.

Excretion:

• The majority of the drug (58% to 84%) is excreted unchanged in the feces, while about 6% is excreted in the urine, 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.