Medications for 'treating' MC - Work in progress as at 1 June 2016
As mentioned in the introduction, MC is complex.
There is no medication protocol that will eradicate MC totally nor for everybody.
Most of the medications provide reduction in major symptoms.
For some, a medication will provide quick reduction in symptoms, for others the strict eating plan and medication will take a few weeks to provide reduction in symptoms.
A medication that works really well for one person, can make things worse for another person.
Based on all of this, it can take a bit of trial and error to find a medication that provides most benefit.
Depending on what country you live in, and the type of health system you have, some medications are not affordable to everybody or available in every country.
NB: some of the medications can have different names in different countries - we have tried to provide the multiple names where we can.
IMPORTANT: this information is provided as information only. We are not Doctors. It is imperative that you speak with a doctor and/or pharmacist about medications, any possible conflict/contra-indication with existing medications/health conditions/supplement protocols
Experience has shown that medications can have limited scope of success if the person is deficient in Vit D3. There is more information about this in the section about Vit D3.
In late 2015 the American GI association provided a revised treatment guideline for MC.
Quote:
Specific recommendations include:
For symptomatic patients, treatment with budesonide is preferable to no treatment, or to treatment with mesalamine, to induce clinical remission.
In symptomatic patients for whom budesonide therapy is not feasible, treatment with mesalamine, bismuth salicylate, or prednisolone (or prednisone) is preferable to no treatment to induce clinical remission.
In symptomatic patients, the American Gastroenterological Association suggests against combination therapy with cholestyramine and mesalamine, vs mesalamine alone, to induce clinical remission.
In symptomatic patients, the association suggests against treatment with Boswellia serrata or probiotics vs no treatment to induce clinical remission.
For patients with recurrent symptoms when induction therapy for microscopic colitis is discontinued, the association recommends budesonide to maintain clinical remission.
We will provide info about these medications first;
Budesonide / Entocort
**for some this can be the price inhibitive option.
Dosage best time to take it:
Long term use:
Re use:
Constipation: - if you start to experience constipation symptoms, then it is time to start a taper protocol.
Tapering: - experience by members is that information about tapering is not very well provided, if at all. Many here have found doing a very gradual taper provides the best long term result.
everyone is different, listen to your body. when going from 6mg per day to 3mg per day, once on 3mg per day if symptoms return, you may need to have 6mg one day, 3mg the next, 6mg the thrid day, 3mg the fourth and so on. Other types of tapers at the 1 x 3mg tablet per day, then proceed to 1 x 3mg tablet every second day. for some it could be 1 x 3mg tablet every third day.
Uceris - variant of budenside
** not currently available in Australia
The Uceris is treated so that it does not become activated until it is well into the colon, so it is not absorbed into the bloodstream and therefore it cannot adversely affect the adrenals the way that Entocort can (even though it uses the same active ingredient).
And it is also 1 capsule per day instead of 3, so a taper is not easy to do. That said, some members taper it anyway, to help prevent a possible rebound effect from mast cells.
Cholestryamine /Questran /Cholybar
** only available as Questran and Questran Lite in Australia
to get a pure version without additives it may need to be sought from Compounding pharmacy
Timing: Cholestryamine affects absorption of fat soluble vitamins and can impair absorption of some medications. users need to have ensure they have it 1-2 hours before and 2-3 hours after eating, medications, taking supplements
Constipation - if constipation starts, do a taper of the medication.
Mesalamine / Salofalk / Lialda / Asacol
Anti-inflammatory drugs can suppress inflammation, but they can cannot prevent it from being regenerated. The best way to stop inflammation from being generated is to stop eating the foods and avoid the triggers that cause our immune system to produce antibodies to them.
Dr Fine (who is a doctor that has MC) has a published article that stated that mesalamine is a derivative of salicylic acid and because of that, most people who have an IBD, and who react to NSAIDS, will experience increased inflammation and D if they take mesalamine, due to increased leukotriene production
Pepto Bismol / Bismuth salicylate
information below posted 3 Dec 2020
8 chewable 262 mg tablets per day. 262 mg is the "standard" Pepto Bismol dose.
The goal to take 525 mg of Pepto 4 times a day is the way I understood it.
In addition, I found this information in the Microscopic Colitis newsletter of November, 2019. The important information I think here is that if you choose to try the Pepto treatment, it should be done in combination with being gluten free.
Dr. Fine no longer recommends the Pepto treatment as a first line treatment for MC, basically for two reasons:
1. Some patients develop tinnitus or neurological issues from using the treatment.
2. The treatment must be done in conjunction with the GF diet, and although remission takes longer without the Pepto Bismol, most MC patients can achieve remission by using the GF diet alone.
Some gastroenterologists still recommend the Pepto treatment today, but they almost always fail to point out that the treatment must be done in conjunction with the GF diet. Consequently, after the treatment ends, their patients usually relapse.
Experience shows that the Pepto treatment is still useful (when used along with the GF diet) for decreasing the amount of time required to reach remission.
-----------------------------------------------------------------------------------
Methods of Trial: Thirteen patients with microscopic colitis (7 with subepithelial collagen deposition and 6 without) were treated with eight chewable 262-mg bismuth subsalicylate tablets per day for 8 weeks. Patients recorded the frequency of bowel movements daily. Forty-eight–hour stool collections and flexible sigmoidoscopy with 24 biopsies were performed before and after treatment in each patient. Results: Twelve patients completed the trial. Eleven patients had a resolution of diarrhea and a reduction in fecal weight. The average time to respond was 2 weeks. In 9 patients, colitis resolved. When present before treatment, subepithelial collagen thickening disappeared. Those completing the trial experienced no side effects. Posttreatment follow-up for 7-28 months shows that 9 patients remain well having undergone no further treatment, 2 are well but required retreatment, and 1 has continued diarrhea.
Loperamide / Immodium /Gastro Stop
these can be used in conjunctions with some of the medications mentioned above,
Double check inactive ingredients - quite a few have lactose
Other Medication options
Antihistamines - Please refer to the Histamine/Mast Cell section
Elavil/Amitriptyline/Endep/Amirol
In low doses, 10-15mg is used for IBS treatment.
Sulfasalazine / Azulfidine
Sulfasalazine is a prodrug, that is to say, it does not become active in the digestive system until it is broken down by bacteria in the colon, into 5-aminosalicylic acid, (5-ASA), and sulfapyridine. While sulfapyradine has a therapeutic effect for rheumatoid arthritis, no beneficial effect from sulfapyradine has been observed for treating inflammatory bowel disease. Since many people tend to react adversely to sulfa drugs, sulfasalazine has mostly been replaced with mesalamine, (sometimes referred to as mesalazine, to further confuse the matter), in the treatment of IBDs.
Rifaximin
A number of members here have tried rifaximin, and a few have tried it multiple times, but as best I can recall, no one has ever reported any benefits that lasted more than just a week or 2. It's claimed to be good for "travelers diarrhea", but unfortunately, MC definitely isn't travelers diarrhea.
Lose Dose Nalderxone - LDN
This has been used by a few members. Thus far, most success has been for those that have multiple AI issues,
based on discussions, it can take a bit of tweaking to figure out the right dose that suits you. Not all doctors will prescribe it for 'off label use' so it may need to be obtained from compounding pharmacy or overseas supplier.
Summary Info - Medications used for MC
"Dr Fine (who is a doctor that has MC) has a published article that stated that mesalamine is a derivative of salicylic acid and because of that, most people who have an IBD, and who react to NSAIDS, will experience increased inflammation and D if they take mesalamine, due to increased leukotriene production"
Could you please post the link to Dr. Fine's article on mesalamine? Thanks!
Could you please post the link to Dr. Fine's article on mesalamine? Thanks!
Here's the link to the article, but like many older medical articles that were once free, it is now available only to people who own a subscription to this journal (NEJM), or purchase the one-time right to read the article. Medical journals have become more greedy in recent years.
https://www.nejm.org/doi/full/10.1056/N ... 3263381320
But that shouldn't be necessary, anyway. Any doctor who is not aware that mesalamine was originally derived from salicylic acid (aspirin), probably shouldn't be writing prescriptions.
Tex
https://www.nejm.org/doi/full/10.1056/N ... 3263381320
But that shouldn't be necessary, anyway. Any doctor who is not aware that mesalamine was originally derived from salicylic acid (aspirin), probably shouldn't be writing prescriptions.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.