**6.2 Oral agents**

Although the precise mechanism of injury in ketamine cystitis has yet to be elucidated, it is clear that it involves inflammation of the urothelium akin to that of interstitial cystitis. Medications that aim to reduce inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, have thus been studied in the treatment of ketamine cystitis symptoms. Other treatment regimens involving the use of antibiotics, anti-muscarinic agents, and beta-3 agonists have also been examined. However, the results from the medication therapy have been suboptimal overall [24].

Medication therapy may not result in significant improvements in LUTS for these patients, but analgesics should still be employed generously. This is because ketamine itself possesses analgesic properties, and therefore abstinence after long periods of abuse may produce pain akin to a withdrawal effect. Analgesics such as paracetamol, phenazopyridine, or even narcotic analgesics such as tramadol may be used on top of NSAIDs in high doses as pain relief during the initial period of detoxification [25].
