Medications And Supplements That May Be Used By MC Patients

[tex]

Hi All,

Obviously there are can be no guarantees that these suggestions will always be safe for every one of us, because not only are we all different in our sensitivities, but manufacturers sometimes change inactive ingredients in products without notice. Always read the label carefully to be sure that medications and supplements do not contain an ingredient that may cause a reaction. With that disclaimer, we (the members of this discussion board) have found the following products to be generally safe for many of us who find it necessary to avoid the most common food sensitivities (associated with MC). But of course these products are not safe for everyone, due to individual differences. Please note all warnings and exceptions which might apply to you, personally. Opinions noted are mine, and as always, YMMV.


Antibiotics:

There are no truly safe antibiotics, because all antibiotics carry a risk of causing adverse events of one type or another, and antibiotics are especially risky for anyone who has MC. Note that it is usually prudent to take a probiotic for a couple of weeks after any antibiotic treatment ends, anytime that ANY antibiotic is used, just to be on the safe side (to help minimize the risk of a C. diff infection). From the viewpoint of how they affect someone who has MC, here are the options that we have found to carry the lowest risk of triggering an MC flare:

azithromycin (Z-Pak)
antibiotics in the fluoroquinolone group, including Ciprofloxacin (see the caution note about the fluoroquinolones below). This group includes:

First-generation

oxolinic acid(Uroxin)
piromidic acid(Panacid)
pipemidic acid(Dolcol)
rosoxacin(Eradacil)

Second-generation

ciprofloxacin(Alcipro,Ciprobay, Cipro, Ciproxin, ultracipro) * See note below
enoxacin(Enroxil, Penetrex)
fleroxacin(Megalone, Roquinol)
lomefloxacin(Maxaquin)
nadifloxacin(Acuatim, Nadoxin, Nadixa)
norfloxacin(Lexinor, Noroxin, Quinabic, Janacin)
ofloxacin(Floxin, Oxaldin, Tarivid)
pefloxacin(Peflacine)
rufloxacin(Uroflox)

Third-generation

Unlike the first- and second-generations, the third-generation is active against streptococci.

balofloxacin(Baloxin)
levofloxacin(Cravit, Levaquin, Tavanic)
pazufloxacin(Pasil, Pazucross)
sparfloxacin(Zagam)
tosufloxacin(Ozex, Tosacin)

Fourth-generation

clinafloxacin[94]
gatifloxacin(Zigat, Tequin) (Zymar -opth.) (Tequin removed from clinical use)
gemifloxacin(Factive)
moxifloxacin(Acflox Woodward, Avelox,Vigamox)
sitafloxacin(Gracevit)
trovafloxacin(Trovan) (removed from clinical use)
prulifloxacin(Quisnon)

In development

delafloxacin— an anionic fluoroquinoline in clinical trials
JNJ-Q2— completed Phase II for MRSA
nemonoxacin


* Caution: Note that the fluoroquinolones have been shown to carry a risk of causing tendonitis, and they can significantly increase the risk of suffering from a torn ligament. Even more importantly, they have also been shown to cause nerve damage in the form of peripheral neuropathy. And more recently, this group of drugs has been shown to be associated with a five-fold increase in the risk of retinal detachment. Please research all the risks before considering taking any antibiotics in this group, because the risks are real.

Tinnitus is another risk that should be considered if a fluoroquinolone is prescribed: I experienced this one myself when I recently took Cipro for a tooth infection. These antibiotics can either cause tinnitus to develop, or make it worse if it is already present.

That said, note that Dr. Carolyn Dean maintains that the tendonitis and tendon-damage risk may be caused by taking a fluoroquinolone while having a magnesium deficienency. She maintains that the fluoroquinolones severely deplete magnesium, which then causes the risk of damage. If that's true, it's certainly possible that the other risks attributed to the fluoruquinolones may also be due to magnesium deficiency. Here's a link to her blog on the subject:

Magnesium Deficiency Can Cause Cipro Damage

The following antibiotics are generally considered to carry the greatest risk of causing problems (a flare or relapse, and/or a higher risk of a C. diff infection) for someone who has MC:

clindamycin (Cleocin)
ampicillin (Omnipen)
amoxicillin (Amoxil, Augmentin, or Wymox)
any antibiotics in the cephalosporin class (such as cefazolin or cephalexin)


Antidepressant/anti-anxiety medications

amitriptyline (Elavil — at very low doses, such as 10 mg, Elavil seems to be relatively well tolerated)
bupropion (Wellbutrin)

Caution: SSRIs and SNRIs are known to cause MC for many patients. At higher (more typical) doses, the tricyclic antidepressants (such as amitriptyline) are also known to trigger the development of MC for some patients.


Antidiarrheals:

loperamide (Imodium)
diphenoxylate and atropine (Lomitil)
bismuth subsalicylate (Pepto-Bismol)


Antihistamines:

H1 receptor antihistamines:

acrivastine
azelastine
bilastine
brompheniramine
buclizine
bromodiphenhydramine
carbinoxamine
cetirizine (Metabolite of Hydroxyzine)
chlorpromazine (antipsychotic)
cyclizine
chlorpheniramine
chlorodiphenhydramine
clemastine
cyproheptadine
desloratadine
dexbrompheniramine
dexchlorpheniramine
dimenhydrinate (most commonly used as an antiemetic)
dimetindene
diphenhydramine (Benadryl)
doxylamine (most commonly used as an OTC sedative)
ebastine
embramine
fexofenadine (Allegra)
hydroxyzine (Vistaril)
levocetirizine
loratadine (Claritin)
meclozine (most commonly used as an antiemetic)
mirtazapine (primarily used to treat depression, also has antiemetic and appetite-stimulating effects)
olopatadine (used locally)
orphenadrine (a close relative of diphenhydramine used mainly as a skeletal muscle relaxant and anti-Parkinsons agent)
phenindamine
pheniramine
phenyltoloxamine
promethazine
pyrilamine
quetiapine (antipsychotic; trade name Seroquel)
rupatadine
tripelennamine
triprolidine

H2 receptor antihistamines:

cimetidine
famotidine
lafutidine
nizatidine
ranitidine
roxatidine

Note that certain other medications prescribed for other purposes (and not typically sold as antihistamines), also have powerful antihistamine effects. Examples of this are the tricyclic antidepressants, such as:

amitriptyline (Tryptomer, Elavil, Endep)
amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)
amoxapine (Asendin) – can be classed with the tetracyclic antidepressants (TeCAs) but more frequently classed with the secondary amine TCAs.
butriptyline† (Evadyne)
demexiptiline† (Deparon, Tinoran)
dimetacrine† (Istonil, Istonyl, Miroistonil)
dosulepin/Dothiepin§ (Prothiaden)
doxepin (Adapin, Sinequan)

But note that the tricyclic antidepressants are known to trigger the development of MC for some patients.

Information on treating mast cell issues with antihistamines plus references that provide additional information

Medications known to either cause histamine reactions or interfere with the production of diamine oxidase:

Acetylcysteine
acetylsalicylic acid (aspirin)
alcuronium
alprenolol
ambroxol
Amiloride
Aminophylline
Amitriptyline
cefotiam
Cefuroxime
choroquine
Cimetidine
clavulanic acid
Cyclophosphamide
Dobutamine
D-tubocurarine
isoniazid
metamizole
Metoclopramide
Morphine
nonsteroidal anti-inflammatory drugs (NSAIDS)
Pancuronium
pentamidin
pethidine
Prilocaine
Propafenone
Thiopental
Verapamil


Antispasmodics:

hyoscyamine (Levsin)


Anti-inflammatory medications:

5-aminosalicylic acid (5-ASA), aka mesalamine (Apriso, Asacol, Asacol HD, Colozal, Ipocal, Lialda, Mezavant, Pentasa, Rowasa, Salofalk)
corticosteroids:

budesonide (Entocort EC, Budez)
prednisolone (Prednisone)

Note that anyone who reacts to NSAIDs will probably also react to mesalamine (and all of the individual brands that are based on mesalamine). Also note that all forms of Asacol contain lactose, which causes some MC patients to react.


Bile acid sequestrants:

Cholestyramine (Questran) (Some patients may have bile acid malabsorption {BAM}, and BAM can cause chronic diarrhea despite dietary changes or medical treatments that are normally effective. For such patients cholestyramine can sometimes bring relief/remission when all else fails. Note however that the "light" version of Questran contains ingredients derived from lactose, and for some patients this can prevent the medication from being effective. The "regular" version of Questran does not contain that ingredient, so it is usually more effective. The dosage rate often has to be determined by trial and error, in order to meet the needs of the patient's digestive system.

Colesevelam (Cholestagel in Europe, Welchol in the USA)
Colestipol (Colestid, Colestipid)


Enzyme supplements:


Low Dose Naltrexone:

If remission remains elusive even after removing all known food sensitivities from the diet and carefully monitoring diet, labels, etc., some members (especially those who have other known autoimmune issues) have found that proper use of a low dose naltrexone regimen can bring remission from virtually all of their symptoms. For more information:

Low-dose Naltrexone (LDN) Fact Sheet 2013


Mineral supplements:

magnesium (Most of us are magnesium-deficient. Oral magnesium citrate is a laxative in larger quantities, but it's usually OK in smaller quantities such as 200 mg or less. Magnesium oxide is the cheapest form of magnesium, and it's poorly absorbed and the most likely form to cause diarrhea. The safest form of oral magnesium is chelated magnesium {magnesium glycinate}. Do not use "buffered" chelated magnesium though, because it is buffered with cheap magnesium oxide. The safest type of magnesium treatment is topical application in an oil or lotion.)

calcium (Large doses can cause adverse cardiac events — daily amounts around 1000 mg or more should be divided into smaller doses taken at spaced-out times during the day. When significant calcium supplements are taken, magnesium and vitamin D3 should also be taken, to ensure that the calcium is properly absorbed out of the bloodstream so that it cannot accumulate there and cause cardiac issues, kidney stones, etc.


Naturopathic and other supplements:


Painkillers:

acetaminophen (Tylenol)
tramadol (Ultram)
narcotic-based painkillers (but beware of impaction risk with narcotics)

Note that many members of this discussion board have successfully used topically-applied analgesics (including NSAIDs) with no apparent ill effects

Vaccines:

Most vaccines based on killed viruses are well tolerated. Be care with attenuated (live virus) vaccines, especially if you have an immunocompromised immune system, or if you are taking an immune system suppressant (including medium to long-term use of a corticosteroid).

Caution is advised during episodes involving significant mast cell reactions. For example, a few members of this discussion board who have significant mast cell issues, have experienced an anaphylactic reaction when they received a flu shot during an episode of an active mast cell reaction.


Vitamins:

Generally safe brands include: Freeda, Kirkman Labs, Thorne Research, Pure Encapsulations, Vital Nutrients, Country Life, and others.

However, always read the label to make sure that none of your food sensitivities are listed.

Vitamin D (D3 is the preferred form) — Most of us need to take supplemental vitamin D, because IBDs deplete vitamin D, and vitamin D insufficiency contributes to the development of additional autoimmune diseases.

Vitamin B-12 (the preferred form is the active form, known as methylcobalamin, and the preferred delivery is by sublingual lozenges, which can be dissolved under the tongue, so that the B-12 can be directly absorbed into the bloodstream, thus bypassing the malabsorption problem in the intestines) — The liver can store enough B-12 to last for up to 5 years. But many of us eventually become B-12 deficient, due to malabsorption problems cause by MC.

Folate (the active form is 5-methyltetrahydrofolate or 5-MTHF) — An adequate level of folate is necessary for the absorption/utilization of vitamin B-12. However, folic acid is not folate (despite supplement manufacturers and merchandisers, doctors, and almost everyone else, trying to equate the two). Folate is found in food, but folic acid is not, so please read the article at the following link for information on the risks of taking folic acid supplements. The little known (but crucial) difference between folate and folic acid

Tex

[ldubois7]

Thanks so much! Where can I find this....on a sticky, or someplace else?

[Marcia K]

Thank you so much for taking the time to post that, Tex. I have a fear of having to take an antibiotic!

[tex]

Thanks so much! Where can I find this....on a sticky, or someplace else?

You've got me confused. How did you find it?

I moved the Information on Medications forum up to the Welcome to Newbies category, and then made this topic an announcement in the Information on Medications forum. There are so many forums on this board, that it's not easy to find a location that's unique and easy to locate.

Your thoughts?

Tex

[tex]

Marcia,

You're very welcome. I still have a long, long way to go, obviously, but I'll continue to work on it as I get the time (or an inspiration).

Tex

[humbird753]

Thank you, Tex. This will be helpful to so many of us. I have also been nervous about if/when I would need to use any of these meds.



You are appreciated more than you'll ever know.

Paula

[ldubois7]

Tex,

I found it originally on the Main Message Board, but now it has moved to Information on Medications.

The sentence beside the heading Information on Medications is this.... This discussion contains information on medications found by some members to be beneficial for the relief of symptoms of microscopic colitis and related issues.

Maybe include a few words that it contains some reasonably safe drugs to try when you have MC??????

Just a thought to make it really easy to find.

[tex]

I didn't edit the description when I moved it, because it contains all sorts of information on meds, but I have now edited it, (hopefully for the better).

Thanks,
Tex

[ldubois7]

It's perfect. Thanks for your hard work!

[CathyMe.]

Thank you so much for taking the time to compile this list Tex! It and you are invaluable!

[Sport]

Tex,

My internist prescribed clonazepam for anxiety. I haven't even thought about it maybe making symptoms worse. Do you know about this medication? Thanks

Sport

[tex]

Hi Sport,

Clonazepam is in the benzodiazepine class of drugs. It's a central nervous depressant, and it's typically prescribed as an anticonvulsant.

I'm not aware of any specific documentation connecting it with the development or exacerbation of MC symptoms, but exceptions are possible with any medication, especially those in the antidepressant/anti-anxiety class (since many of them have been shown to be associated with the development of MC).

Since clonazepam is capable of causing the development of a dependency, it may not be possible to simply stop taking it for a few days to see if it's affecting your MC symptoms.

One of the safest anti-anxiety medications for someone who has MC appears to be bupropion (Wellbutrin). It typically has the lowest risk of undesirable side effects, and several members of this discussion board are taking it, I believe.

Tex

[mcnomore]

Thanks Tex, grateful for your hard work.

[robinc2525]

Thank you Tex! You do so much for us :)

[janet]

TEX. THANKYOU SOMUCH, ALL YOUR HARD WORK.
I CAN ASSURE YOU IS GREATLY APPRECIATED.
IT WILL BE A GREAT HELP TO ME, AND SO MANY OF US.

THANKYOU ONCE AGAIN TEX.

SINCERELY MEANT
MARIE