From the Guidelines
Several medications can cause microscopic colitis, with nonsteroidal anti-inflammatory drugs (NSAIDs) being the most common culprits, including ibuprofen, naproxen, and aspirin, as well as proton pump inhibitors (PPIs) like omeprazole and esomeprazole, and other medications such as selective serotonin reuptake inhibitors (SSRIs), statins, acarbose, ranitidine, and certain antibiotics including penicillins and cephalosporins 1.
Medications Associated with Microscopic Colitis
- Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen, aspirin
- Proton pump inhibitors (PPIs): omeprazole, esomeprazole
- Selective serotonin reuptake inhibitors (SSRIs): sertraline, fluoxetine
- Statins: atorvastatin
- Acarbose
- Ranitidine
- Certain antibiotics: penicillins, cephalosporins
Management of Microscopic Colitis
If microscopic colitis is suspected, the first step should be discontinuation of the suspected medication when possible, as the mechanism involves drug-induced mucosal injury that triggers an inflammatory response in the colon, leading to the characteristic symptoms of watery diarrhea 1.
Additional Treatment
Symptoms typically improve within days to weeks after stopping the offending medication, though some cases may require additional treatment with medications like budesonide, which has been shown to be effective in inducing clinical remission in patients with microscopic colitis 1.
Quality of Life and Monitoring
Patients should be aware that multiple medications might need to be evaluated, and close monitoring after medication discontinuation is important to confirm the diagnosis, with consideration of the potential impact on quality of life and the need for ongoing management to prevent recurrence or complications 1.
From the Research
Medications Associated with Microscopic Colitis
- Nonsteroidal anti-inflammatory drugs (NSAIDs) have been consistently associated with an increased risk of microscopic colitis (MC) 2, 3, 4, 5, 6
- Proton pump inhibitors (PPIs) have also been linked to MC, although one study found an inverse association 2, 4, 5, 6
- Selective serotonin reuptake inhibitors (SSRIs) have been implicated in some studies, but the evidence is less consistent 2, 4, 5
- Statins have not been found to be associated with MC 4
- Aspirin and other NSAIDs were more commonly used among patients who developed MC 3
- Concomitant use of PPIs and NSAIDs showed the highest risk of MC 4
Mechanisms and Risk Factors
- The exact mechanisms by which these medications contribute to MC are unclear, but may involve acid suppression-related dysbiosis and NSAID-related side effects 4
- Increasing age, female sex, and presence of other autoimmune diseases are also risk factors for MC 2
- The use of certain medications, including NSAIDs and PPIs, may trigger colonic inflammation in predisposed hosts or worsen diarrhea in undiagnosed patients 3