Treatment of microscopic and collagenous colitis in adults
Microscopic and collagenous colitis are associated with use of certain classes of medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs) and selective serotonin reuptake inhibitors (SSRIs). Stop any drugs that are temporally associated with the onset of symptoms.
Initial therapy for patients with microscopic and collagenous colitis who have ongoing symptoms is an enteric-coated preparation of budesonide (eg Entocort, Budenofalk)Nguyen, 2016. Use:
budesonide enteric-coated 9 mg orally, daily in the morning for 4 to 8 weeks, then taper over 2 to 4 weeks in 3 mg increments to stop. budesonide budesonide budesonide
If symptoms recur during tapering or after stopping therapy, consider a longer course of budesonide, using the lowest dose required to control symptoms.
If budesonide is not tolerated, or for recurrent symptoms that do not respond to a repeated course of budesonide, use:
colestyramine 2 to 4 g orally, daily. colestyramine colestyramine colestyramine
All other drugs should be taken at least 1 hour before, or 4 to 6 hours after colestyramine.
For microscopic and collagenous colitis that does not respond to budesonide or colestyramine, an immunomodulatory drug or biological therapy may be used.