Can over-the-counter (OTC) antidiarrheal medications be taken by someone with ulcerative colitis?

From the Guidelines

Individuals with colitis should avoid taking over-the-counter antidiarrheals unless specifically advised by their healthcare provider. This is because medications like loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol), and diphenoxylate-atropine (Lomotil) can potentially worsen colitis by slowing intestinal motility, which may lead to toxic megacolon—a dangerous complication where harmful bacteria and toxins become trapped in the colon 1.

Key Considerations

• The use of antimotility drugs, such as loperamide, is generally not recommended in patients with suspected or proven cases of inflammatory diarrhea or diarrhea with fever, as it may increase the risk of toxic megacolon 1.
• Instead of self-medicating, patients with colitis should contact their gastroenterologist when experiencing diarrhea flares, as the appropriate treatment typically involves addressing the underlying inflammation with prescription medications such as corticosteroids, immunomodulators, or biologics 1.
• During mild flares, staying hydrated, following a low-residue diet, and using prescribed medications are safer approaches than OTC antidiarrheals.

Treatment Options

• The American Gastroenterological Association (AGA) recommends using infliximab, adalimumab, golimumab, vedolizumab, tofacitinib, or ustekinumab for the induction and maintenance of remission in adult outpatients with moderate to severe ulcerative colitis 1.
• The choice of treatment should be individualized based on the patient's condition severity, overall health status, and preferences.

Important Reminders

• Patients with colitis should always consult their healthcare provider before taking any medication, including over-the-counter antidiarrheals.
• If a healthcare provider does recommend an antidiarrheal, they will provide specific instructions regarding dosage and duration based on the individual's condition severity and overall health status.

From the Research

Antidiarrheal Use in Colitis

• The use of over-the-counter antidiarrheals in patients with colitis is a complex issue, and the decision to use them should be made on a case-by-case basis 2.
• In patients with microscopic colitis, antidiarrheals such as loperamide may be used as the initial choice for mild symptoms 2.
• However, in patients with severe colitis or toxic megacolon, medical management is crucial, and the use of antidiarrheals may not be sufficient 3, 4, 5.
• In fact, the primary focus in managing severe colitis and toxic megacolon is on medical management, with surgical intervention considered only when necessary 4, 5.

Considerations for Antidiarrheal Use

• The type and severity of colitis, as well as the patient's overall health, should be taken into account when considering the use of antidiarrheals 2, 6.
• Patients with ulcerative colitis, for example, may require more aggressive treatment, including immunomodulator and/or biologic therapies, to manage their symptoms 6.
• In contrast, patients with microscopic colitis may be able to manage their symptoms with antidiarrheals and other supportive measures 2.

Important Notes

• The use of antidiarrheals in patients with colitis should be guided by a healthcare professional, as the decision to use them depends on various factors, including the type and severity of colitis, as well as the patient's overall health 2, 6.
• Patients with colitis should be closely monitored for any changes in their symptoms or condition, and adjustments to their treatment plan should be made as needed 3, 4, 5.