Pentosan Polysulfate
Also known as: PPS, Elmiron
An FDA-approved oral medication (Elmiron) for interstitial cystitis (painful bladder syndrome). Also being studied as an injectable for osteoarthritis, where it may act as a disease-modifying agent. Carries an important warning about potential eye damage with long-term use.
How it works
For bladder conditions, PPS is thought to coat the bladder wall and repair its protective lining, reducing pain and urgency. For joints, injectable PPS may reduce cartilage breakdown, improve bone marrow lesions, and have anti-inflammatory effects. It also has mild blood-thinning properties.
Common uses
- Interstitial cystitis / painful bladder syndrome (FDA-approved)
- Osteoarthritis pain and joint repair (off-label, injectable form)
- Bone marrow lesion treatment (investigational)
Side effects
- Hair loss (alopecia)
- Diarrhea and nausea
- Headache
- Abdominal pain
- Increased risk of bleeding
- Macular eye damage with long-term use (pigmentary maculopathy, affects roughly 1 in 4 patients after 5+ years)
- Liver enzyme elevations (rare)
Key research
- Approved by FDA in 1996 for interstitial cystitis based on clinical trials showing reduced bladder pain
- MaRVeL Phase 2 trial studying injectable PPS for knee osteoarthritis and dyslipidemia
- Pilot studies show injectable PPS improves painful bone marrow lesions in knee OA patients
- Ophthalmology study found about 25% of long-term users (5+ years) developed significant retina damage
Safety notes
- FDA-approved only for interstitial cystitis, not for osteoarthritis
- Black box warning added in 2020 for pigmentary maculopathy (eye damage)
- Regular eye exams recommended for anyone taking Elmiron long-term
- Increased bleeding risk. Use caution with blood thinners, aspirin, or NSAIDs
- Injectable form for joints is still investigational and off-label in the U.S.
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