From the Guidelines
If colitis is not responding to Imodium, the most appropriate next step is to consider biologic agents such as infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab, as recommended by the AGA guidelines 1. These medications are preferred over no treatment for moderate to severe ulcerative colitis, with the choice of biologic agent depending on factors such as prior exposure to biologics and patient preferences. Key considerations include:
- The strength of recommendation for using biologic agents over no treatment is strong, with moderate quality evidence 1.
- For patients naive to biologic agents, infliximab or vedolizumab may be preferred for induction of remission, although patient preferences for convenience and efficacy should be considered 1.
- The use of tofacitinib is recommended only in biologic-naive patients in the setting of a clinical or registry study, or after failure of, or intolerance to TNFα antagonists, based on updated FDA recommendations 1. While waiting for medical care, it is essential to maintain hydration, avoid trigger foods, and track symptoms. Continuing Imodium without addressing the underlying inflammation can potentially worsen the condition. Proper diagnosis and treatment approach are crucial for effective management, considering the different types of colitis and their specific treatment requirements. Additionally, considering differentials at the time of diagnosis and when there is an incomplete response to treatment or flare, such as infection, proximal constipation, Crohn's disease, co-existent irritable bowel syndrome, and rectal prolapse/solitary rectal ulcer, is important 1.
From the FDA Drug Label
1.3 Ulcerative Colitis RENFLEXIS is indicated for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy. The recommended dosage for the induction of remission in adult patients with mildly to moderately active ulcerative colitis is 2.4 g to 4.8 g (two to four 1.2-g tablets) taken once daily.
Colitis not responding to Immodium may be treated with alternative medications.
- Infliximab (IV) 2 is indicated for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.
- Mesalamine (PO) 3 is recommended for the induction of remission in adult patients with mildly to moderately active ulcerative colitis at a dosage of 2.4 g to 4.8 g taken once daily.
From the Research
Colitis Not Responding to Immodium
- Colitis is a chronic inflammatory disease of the colon, and its treatment depends on the severity and extent of the disease 4.
- Immodium (loperamide) is an antidiarrheal medication that may be used to manage symptoms of colitis, but it is not a primary treatment for the disease 5.
- For patients with colitis who are not responding to Immodium, other treatment options may be considered, such as:
- 5-aminosalicylates (5-ASAs) like mesalamine, which are considered first-line therapy for ulcerative colitis 6, 7, 8.
- Corticosteroids, which may be used to induce remission in patients with more severe disease 4.
- Immunomodulators, which may be used in patients with recurrent symptoms or those who do not respond to other treatments 5.
- The choice of treatment depends on the specific type and severity of colitis, as well as the patient's overall health and medical history 4, 8.
- It is essential to work with a healthcare provider to determine the best course of treatment for colitis that is not responding to Immodium.