Bladder Cocktails

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Bladder Cocktails

Below are some ICA Medical Advisory Board members’ bladder cocktail recipes. Many patients may be able to do instillations of these cocktails at home, after in-office education. If a solution causes your patient dysuria, it can be drained by catheter. In that case, in-office administration is more practical.

Kristene Whitmore, MD—Drexel University College of Medicine

Whitmore Cocktail

0.5% bupivacaine (Marcaine, 20 mL)
10,000 IU heparin (10 mL)
100 mg hydrocortisone (5 mL of normal saline)
40 mL sodium bicarbonate 48 mmol

Try using with patients who self-administer at home. For patients who have had a documented UTI within three months of the instillation, add 80 mg gentamicin (5 mL of normal saline) to this mixture.

Usually, give six weekly instillations. For patients who have premenstrual flares, try giving monthly instillations during the flare.

Robert Moldwin, MD—Smith Institute for Urology & Long Island Jewish Medical Center

Anesthetic/Steroid cocktail

1:1 mixture of 0.5% bupivacaine (Marcaine) and 2% lidocaine jelly (about 30 to 40 mL total)
40 mg triamcinolone (usually use 80 mg for Hunner's ulcer patients)
10-20,000 IU heparin
80 mg gentamicin

Perform this instillation weekly in the office, or up to three times a week by patients at home. Longer-lasting improvement in symptoms may take up to 12 weeks. Once symptoms have improved, increase the time between instillations. In instances where patients describe loss of cocktail efficacy, we usually switch to "DMSO cocktail" and may come back to the anesthetic cocktail at a later date, if needed.

Alkalinized lidocaine cocktail

25 mL 2% lidocaine
5 mL sodium bicarbonate
10,000 IU heparin
80 mg gentamicin

In studies with alkalinized lidocaine, bicarbonate was instilled after lidocaine, but mixing this solution and instilling it “fresh” should avoid problems with precipitation.

DMSO cocktail

50 mL Rimso-50 (DMSO)
10-20,000 IU heparin
40 mg triamcinolone
10 mL sodium bicarbonate
80 mg gentamicin

Christopher Payne, MD—Stanford University

Payne Cocktail I

10,000 IU of heparin
10 mL of bupivacaine (Marcaine)

Usually prescribe for self-instillation daily or three times a week. Sometimes, use this cocktail as a weekly office treatment.

Payne Cocktail II

50 mL of Rimso-50 (DMSO)
100 mg hydrocortisone (Solu-Cortef) plus 10 mL bupivacaine (Marcaine)
5 mL sodium bicarbonate
Heparin (may add heparin; however, heparin is usually reserved as a separate treatment)

Instill 30 to 50 mL of the above into the bladder and ask the patient to try to hold the solution for 30 minutes. Belladonna and opium (B & O Supprettes) rectal suppositories may be used to help hold the cocktail in the bladder for longer periods. Perform instillations each week for six to eight weeks. If there is improvement, decrease the time between instillations to two weeks, three weeks, one month, and then discontinue.

Revised February 8, 2009