0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59
Ulcerative Colitis 1479■side effects of Aza or 6MP: fatigue, nausea, bone marrow depres-
sion, opportunistic infections, pancreatitis, hepatitis, fever, rarely
lymphoma
➣Methotrexate if intolerant to Aza or 6MP. Induction dose: 25
mg i.m. weekly for 16 weeks. Maintenance dose: 15 mg i.m.
weekly.
■side effects of methotrexate: fatigue, nausea, diarrhea, leukopenia,
opportunistic infections, liver disease
➣consider anti-TNF alpha if Aza, 6MP or methotrexate cannot be
tolerated or is ineffective. Caution: we need more data on its
effectiveness for maintaining long-term remission.
Active colitis:Topical Therapy
■works faster and better than oral medication and less is absorbed
■mesalamine suppositories or enemas for mild proctitis or for main-
tenance therapy
■hydrocortisone enemas (100 mg) for more severe flares of proctitis
or proctosigmoiditis (about one third of the enema is absorbed)Oral Corticosteroids
■oral prednisone at 40 mg/day with gradual tapering – usually faster
at higher doses and slower at lower doses (e.g., 5 mg/week initially
and then 2.5 mg/week when <20 mg/day)
■short-term side effects include acne, night sweats, sleep and mood
disturbances, appetite stimulation
■long-term side effects include hypertension, diabetes, acne, osteo-
porosis, osteonecrosis, glaucoma, cataracts, life-threatening infec-
tions, depression and obesity
■Budesonide (9 mg/d); Caution: may not be as effective as prednisone
and has long-term steroid toxicities
■There is no place for frequent or long-term systemic steroids (includ-
ing budesonide) in the management of IBD because the adverse
effects outweigh the potential benefits.Severe Colitis (Refractory to Oral Medications)
■admit to hospital; stool studies and colonic biopsies to rule out infec-
tious diseases; abdominal CT scan
■iv corticosteroids (methylprednisolone 60 mg/day) and hydrocorti-
sone enemas
■TPN is usually unnecessary in patients capable of eating.