Overview

When you’re dealing with bladder symptoms—burning, urgency, constant trips to the toilet—medication is often part of the solution. But which medication, and when? The answer depends entirely on what’s causing your symptoms in the first place.

This guide covers the main medication options for common bladder conditions, from over-the-counter remedies you can pick up at the pharmacy to prescription antibiotics and specialist treatments. I’ll be upfront: this isn’t medical advice, and you should always discuss treatment options with your GP or specialist. But understanding what’s available helps you have better conversations with healthcare professionals.

Over-the-Counter Remedies for Cystitis

If you’ve ever had a bout of bacterial cystitis, you know the drill: that horrible burning sensation, feeling like you need to urinate constantly, and the general misery of a bladder that won’t leave you alone. For mild symptoms, especially if you’ve had cystitis before and recognise the signs early, over-the-counter remedies from your local pharmacy can help ease discomfort while your body fights the infection—or while you wait to see your GP.

Urinary Alkalinisers

The most common OTC products for cystitis contain potassium citrate or sodium citrate. Brand names in the UK include Cymalon, Cystopurin, and CanesOasis. These sachets work by making your urine less acidic (more alkaline), which can reduce the burning sensation when you urinate.

Here’s how to use them:

Dissolve the sachet contents in water as directed
Take three times daily for up to two days
Drink plenty of extra fluids alongside the treatment
Complete the course even if symptoms improve

Important caveats: Urinary alkalinisers don’t actually treat the underlying infection—they just make urination less painful. If your symptoms don’t improve within 48 hours, or if they worsen, you need to see your GP for antibiotics. The NHS is clear on this point: these products provide symptom relief, not cure 1.

Also check with your GP or pharmacist before using these products if you:

Have kidney problems
Have heart conditions
Take medications for blood pressure or heart failure
Are pregnant
Have diabetes

Some of these products contain sodium, which matters if you’re on a salt-restricted diet. Others contain potassium, which can be problematic if you’re taking certain heart or blood pressure medications.

Pain Relief

Standard painkillers can help manage cystitis discomfort:

Paracetamol is safe for most people and can reduce the general feeling of being unwell that often accompanies bladder infections.

Ibuprofen (or other NSAIDs) can help with inflammation and pain. However, some research suggests NSAIDs might slightly delay recovery from UTIs, so paracetamol may be the better first choice 2.

A hot water bottle on your lower abdomen or between your thighs can also provide surprising relief—not a medication, but worth mentioning.

What About Cranberry Products?

You’ll find plenty of cranberry supplements and drinks marketed for urinary health. The evidence for cranberry in treating active cystitis is weak—once you have an infection, cranberry isn’t going to clear it. However, there’s reasonable evidence that regular cranberry consumption may help prevent recurrent UTIs. A 2023 Cochrane review found cranberry products reduced the risk of symptomatic UTIs, particularly in women with recurrent infections 3.

For more detail on the evidence, see our article on cranberry supplements.

Antibiotics for Bacterial Cystitis

If OTC remedies aren’t cutting it, or if your symptoms are moderate to severe from the start, you’ll need antibiotics. This requires a prescription from your GP.

First-Line Antibiotics

The two most commonly prescribed antibiotics for uncomplicated cystitis in the UK are:

Nitrofurantoin (brand name Macrobid, among others) is often the first choice. It’s taken twice daily for three days (immediate-release) or once daily for seven days (modified-release). Nitrofurantoin works well against the bacteria that typically cause UTIs and doesn’t contribute as much to antibiotic resistance as some alternatives.

Trimethoprim is another common option, usually taken twice daily for three days. It’s been around for decades and works well for many people. However, bacterial resistance to trimethoprim has increased over the years, which is one reason nitrofurantoin is now often preferred.

Other Antibiotic Options

If first-line treatments don’t work or aren’t suitable, your GP may prescribe:

Fosfomycin — A single-dose antibiotic, convenient but not always the most effective
Pivmecillinam — Sometimes used as a second-line option
Amoxicillin or co-amoxiclav — May be used if culture shows the bacteria are sensitive
Cefalexin — A cephalosporin antibiotic, sometimes reserved for more resistant infections

The specific choice depends on several factors: your medical history, any drug allergies, what’s worked (or hasn’t worked) before, and local patterns of antibiotic resistance. If your GP sends a urine sample for culture, the lab results can identify exactly which antibiotics will work against your specific infection.

Tips for Taking Antibiotics

A few practical points:

Complete the course. Even if you feel better after a day or two, finish all the antibiotics. Stopping early can allow resistant bacteria to survive and cause a relapse.

Be aware of side effects. Nausea, diarrhoea, and yeast infections (thrush) are common with antibiotics. If side effects are severe, contact your GP—there may be alternatives.

Watch for allergic reactions. Rash, swelling, difficulty breathing, or severe skin reactions require immediate medical attention.

Timing matters for some antibiotics. Nitrofurantoin should be taken with food to improve absorption and reduce stomach upset. Check the instructions that come with your prescription.

When Antibiotics Don’t Work

Sometimes a course of antibiotics doesn’t clear the infection completely. This might happen because:

The bacteria are resistant to the antibiotic used
The antibiotic didn’t reach adequate levels in the urine
There’s an underlying issue preventing complete clearance
It wasn’t actually bacterial cystitis in the first place

If symptoms persist after completing antibiotics, go back to your GP. They may:

Send another urine sample for culture and sensitivity testing
Prescribe a different antibiotic based on the results
Consider a longer course of treatment
Refer you for further investigation

Recurrent UTIs—typically defined as two or more infections in six months, or three or more in a year—warrant specialist assessment to rule out underlying causes and discuss preventive strategies.

Medications for Other Bladder Conditions

Bacterial cystitis isn’t the only bladder problem that responds to medication. Other conditions have their own treatment approaches.

Overactive Bladder

Overactive bladder (OAB) causes urgency, frequency, and sometimes incontinence—but urine cultures come back negative. Antibiotics won’t help because there’s no infection.

Instead, OAB is managed with medications that calm the bladder muscle:

Anticholinergics (antimuscarinics) like oxybutynin, solifenacin, and tolterodine reduce bladder muscle contractions. They work, but side effects—dry mouth, constipation, and cognitive effects in older adults—limit their use for some people.

Beta-3 agonists like mirabegron offer an alternative mechanism without the anticholinergic side effects, though they can affect blood pressure and aren’t suitable for everyone.

For detailed information, see our guide to medication for OAB.

Interstitial Cystitis and Painful Bladder Syndrome

Interstitial cystitis (IC) and painful bladder syndrome (PBS) are chronic conditions with symptoms similar to bacterial cystitis but no identifiable infection. Treatment is challenging and often involves trial and error.

Oral medications that may help include:

Amitriptyline — A tricyclic antidepressant that can reduce bladder pain and urgency
Hydroxyzine — An antihistamine that may help if mast cell activation plays a role
Pentosan polysulfate sodium (Elmiron) — Designed to repair the bladder lining, though recent concerns about eye toxicity have limited its use

For many IC/PBS patients, intravesical medications—treatments instilled directly into the bladder—offer better results than oral medications. These include hyaluronic acid preparations (Cystistat, Hyacyst), chondroitin sulphate (Gepan), and DMSO.

Preventing Recurrent UTIs

For people prone to frequent urinary tract infections, preventive medication may be appropriate:

Low-dose prophylactic antibiotics can be taken daily or after sexual intercourse (if that’s a trigger) to prevent infections. Common choices include nitrofurantoin, trimethoprim, and cefalexin. This approach reduces infection frequency significantly, but long-term antibiotic use has downsides including yeast infections and contribution to antibiotic resistance.

Methenamine hippurate (Hiprex) is an alternative that works by converting to formaldehyde in acidic urine, which kills bacteria. It’s not an antibiotic in the traditional sense and doesn’t cause resistance. A 2022 study found it comparable to low-dose antibiotics for preventing recurrent UTIs 4.

Topical oestrogen helps postmenopausal women by restoring vaginal flora that protect against UTIs. It’s applied as a cream or pessary and is well-tolerated with minimal systemic absorption.

D-mannose is a natural sugar that may prevent E. coli (the most common UTI-causing bacterium) from sticking to the bladder wall. The evidence is promising but not definitive. See our article on D-mannose for details.

Drug Interactions and Precautions

Some important points to discuss with your GP or pharmacist:

Blood thinners: Some antibiotics (including trimethoprim and certain others) can interact with warfarin, increasing bleeding risk. If you take anticoagulants, mention this when getting any new prescription.

Methotrexate: Trimethoprim should generally be avoided if you take methotrexate, as the combination increases toxicity risk.

Kidney function: Nitrofurantoin isn’t suitable for people with significantly reduced kidney function. Your GP will consider this when choosing an antibiotic.

Pregnancy: Some antibiotics are safer than others during pregnancy. Nitrofurantoin and amoxicillin are generally considered safe in most circumstances, while others should be avoided. Always tell your GP if you’re pregnant or might be.

Breastfeeding: Most UTI antibiotics are compatible with breastfeeding, but check with your GP or pharmacist.

When to See a Doctor

OTC remedies and self-care are appropriate for mild, uncomplicated cystitis in otherwise healthy women who’ve had the condition before. However, see your GP if:

Symptoms don’t improve within 48 hours of starting OTC treatment
You develop fever, chills, back pain, or feel very unwell
There’s blood in your urine
You’re pregnant
You’re a man (UTIs in men often indicate underlying issues)
A child has symptoms of cystitis
You have diabetes, kidney problems, or a weakened immune system
This is your first UTI and you’re not sure what you’re dealing with
You have recurrent infections

Symptoms suggesting the infection has spread to the kidneys (pyelonephritis)—high fever, severe back or flank pain, vomiting, or shaking chills—require urgent medical attention. This is a serious condition that may need hospital treatment.

A Note on Self-Diagnosis

One pitfall I see regularly: people assuming bladder symptoms must be a UTI, taking antibiotics (sometimes from a previous prescription or from someone else), and wondering why they’re not getting better. The truth is, several conditions cause similar symptoms:

Interstitial cystitis mimics UTI symptoms but isn’t bacterial
Overactive bladder causes urgency and frequency without infection
Atrophic vaginitis in postmenopausal women can cause burning and frequency
Sexually transmitted infections may cause urethral symptoms
Some medications can irritate the bladder

If your “UTI” doesn’t respond to treatment, or if you keep getting diagnosed with UTIs despite negative cultures, push for further investigation. Something else may be going on.

Practical Summary

For a straightforward bout of bacterial cystitis:

Try OTC alkalinising sachets and paracetamol for mild symptoms
Drink plenty of fluids
See your GP if symptoms don’t improve within 48 hours, or sooner if they’re severe
Take prescribed antibiotics exactly as directed, completing the full course
Return if symptoms persist after finishing antibiotics

For chronic or recurrent bladder problems, work with your GP or a specialist to find the right combination of treatments. What works varies enormously between individuals, so be patient with the process and advocate for yourself if you feel your concerns aren’t being addressed.

For more information on bladder conditions and management strategies, explore our guides to cystitis, lifestyle changes for bladder health, and specific conditions like interstitial cystitis and recurrent UTIs.

References

NHS. Cystitis. NHS website. Accessed 2024. https://www.nhs.uk/conditions/cystitis/
Gágyor I, et al. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ. 2015;351:h6544. PubMed
Williams G, et al. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2023;4(4):CD001321. PubMed
Harding C, et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022;376:e068229. PubMed