Severe cystitis associated with tiaprofenic acid

Objective  To review the UK spontaneous reports of urinary disorders associated with tiaprofenic acid and other non-steroidal anti-inflammatory drugs (NSAIDs) and put them into context of the usage of these preparations in the UK. Methods  Suspected adverse drug reaction (ADR) reports of urinary disorders associated with tiaprofenic acid and other NSAIDs received by the UKs spontaneous ADR reporting scheme were analysed. Results  Between 1982, when tiaprofenic acid was introduced in the UK, and August 1994, 69 cases of cystitis were reported, with a further 32 reports describing related urinary symptoms including frequency, dysuria and haematuria. Only eight cases of cystitis were reported for all other NSAIDs. The duration of treatment with tiaprofenic acid before the onset of urinary symptoms varied markedly (range 2 days to >3 years). In patients in whom a drug-induced cause was suspected and the drug was stopped promptly, recovery usually occurred within weeks. However, many patients continued on long-term treatment with tiaprofenic acid and underwent extensive investigations to determine the cause of their urinary symptoms. On cystoscopy and biopsy, the findings were similar to interstitial cystitis. Most patients with chronic cystitis recovered after withdrawal of tiaprofenic acid, but some patients had surgery before the drug was stopped. Conclusion  Tiaprofenic acid can cause severe cystitis. These reports highlight the importance of taking a full drug history in patients with unexplained chronic cystitis. Tiaprofenic acid should be stopped immediately in all patients developing urinary symptoms.