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By: Paul Reynolds, PharmD, BCPS
- Critical Care Pharmacy Specialist, University of Colorado Hospital
- Clinical Assistant Professor, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
http://www.ucdenver.edu/academics/colleges/pharmacy/Departments/ClinicalPharmacy/DOCPFaculty/Q-Z/Pages/Paul-Reynolds,-PharmD.aspx
Fertility Limited data is available on human fertility but no safety concern has been identified allergy medicine 9\/3 discount benadryl line. Objective measurements of driving ability allergy symptoms with eyes generic benadryl 25 mg without prescription, sleep latency and assembly line performance have not demonstrated any clinically relevant effects at the recommended dose of 10 mg allergy forecast for philadelphia best 25mg benadryl. However patients who experience somnolence should refrain from driving allergy testing eosinophilic esophagitis cheap 25mg benadryl fast delivery, engaging in potentially hazardous activities or operating machinery. They should not exceed the recommended dose and should take their response to the medicinal product into account. Although cetirizine is a selective antagonist of peripheral H1-receptors and is relatively free of anticholinergic activity, isolated cases of micturition difficulty, eye accommodation disorders and dry mouth have been reported. Instances of abnormal hepatic function with elevated hepatic enzymes accompanied by elevated bilirubin have been reported. Mostly this resolves upon discontinuation of the treatment with cetirizine hydrochloride. From this pooling, the following adverse events were reported for cetirizine 10mg in the placebo-controlled trials at rates of 1. Objective tests as demonstrated by other studies have demonstrated that usually daily activities are unaffected at the recommended daily dose in healthy young volunteers. Adverse events reported after an intake of at least 5 times the recommended daily dose are: confusion, diarrhoea, dizziness, fatigue, headache, malaise, mydriasis, pruritus, restlessness, sedation, somnolence, stupor, tachycardia, tremor, and urinary retention. Pharmacotherapeutic group: antihistamine for systemic use, piperazine derivatives. In vitro receptor binding studies have shown no measurable affinity for other than H1-receptors. Pharmacodynamics effects In addition to its anti-H1 effect, cetirizine was shown to display anti-allergic activities: at a dose of 10 mg once or twice daily, it inhibits the late phase recruitment of eosinophils, in the skin and conjunctiva of atopic subjects submitted to allergen challenge. Clinical efficacy and safety Studies in healthy volunteers show that cetirizine, at doses of 5 and 10 mg strongly inhibits the wheal and flare reactions induced by very high concentrations of histamine into the skin, but the correlation with efficacy is not established. In a six-week, placebo-controlled study of 186 patients with allergic rhinitis and concomitant mild to moderate asthma, cetirizine 10mg once daily improved rhinitis symptoms and did not alter pulmonary function. This study supports the safety of administering cetirizine to allergic patients with mild to moderate asthma. At the recommended dosage, cetirizine has demonstrated that it improves the quality of life of patients with perennial and seasonal allergic rhinitis. Paediatric population In a 35-day study in children aged 5 to 12, no tolerance to the antihistamine effect (suppression of wheal and flare) of cetirizine was found. When a treatment with cetirizine is stopped after repeated administration, the skin recovers its normal reactivity to histamine within 3 days. Absorption The steady-state peak plasma concentrations is approximately 300 ng/ml and is achieved within 1. The extent of bioavailability is similar when cetirizine is given as solutions, capsules or tablets. Elimination The terminal half-life is approximately 10 hours and no accumulation is observed for cetirizine following daily doses of 10 mg for 10 days. Linearity/Non-linearity Cetirizine exhibits linear kinetics over the range of 5 to 60 mg. Special populations Elderly: Following a single 10 mg oral dose, half life increased by about 50% and clearance decreased by 40% in 16 elderly subjects compared to the normal subjects. The decrease in cetirizine clearance in these elderly volunteers appeared to be related to their decreased renal function. Paediatric population: The half-life of cetirizine was about 6 hours in children of 6 – 12 years and 5 hours in children 2 – 6 years. Renal impairment: The pharmacokinetics of the drug were similar in patients with mild impairment (creatinine clearance higher than 40 ml/min) and healthy volunteers. Patients with moderate renal impairment had a 3-fold increase in half-life and 70% decrease in clearance compared to healthy volunteers. Patients on hemodialysis (creatinine clearance less than 7 ml/min) given a single oral 10 mg dose of cetirizine had a 3-fold increase in half-life and a 70% decrease in clearance compared to normals. Dosing adjustment is necessary in patients with moderate or severe renal impairment (see section 4. Hepatic impairment: Patients with chronic liver disease (hepatocellular, cholestatic, and biliary cirrhosis) given 10 or 20 mg of cetirizine as a single dose had a 50 % increase in half life along with a 40 % decrease in clearance compared to healthy subjects. Dosing adjustment is only necessary in hepatically impaired patients if concomitant renal impairment is present. Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, toxicity to reproduction. Lactose Monohydrate, Microcrystalline Cellulose, Maize Starch, Colloidal Anhydrous Silica, Magnesium Stearate & Talc. Film coat contains: Hypromellose, Lactose monohydrate, Titanium Dioxide, Macrogol 4000 & Sodium Citrate. Other data pertaining to the consumption as well as the production aspects are cited in the study. Also, the businesses across the world have encountered scarcity of labor workforce and lack of raw materials in the wake of the highly contagious disease, which is projected to result in modification in Cetirizine Hydrochloride market growth rate in the upcoming years. Moreover, the report offers specifics regarding the projected growth rate of each topography during the analysis timeframe. A gist of the product landscape: The research report provides with a granular evaluation of the product spectrum of the Cetirizine Hydrochloride market. Other data pertaining to the revenues accrued by each application segment is also cited. Information concerning the product specification and their application scope are described in the study. The Goal Of The Report: The key objective of this research study is to provide a clear picture and a better understanding of the market to the manufacturers, suppliers, and the distributors. Who are the too vendors in Global Cetirizine Hydrochloride Market and what is their market share? Oral dosage (chewable tablets) 5 to 10 mg orally once daily, depending on severity of symptoms. If needed, the dose may be increased to 5 mg once daily using the chewable tablet. Children and Adolescents 2 to 17 years 1 drop in the affected eye(s) twice daily (approximately 8 hours apart). Specific dosing recommendations are not available for children 3 to 5 years old; based on dosing used for allergic rhinitis, consider 2. Children less than 6 years: Use is not recommended due to lack of data in hepatically-impaired pediatric patients in this age group. Intravenous InjectionNo dosage adjustment is required in patients with hepatic impairment; however these patients should be monitored for antihistaminic side effects. Administer cetirizine injection as an intravenous push over a period of 1 to 2 minutes. Do not remove the cap from the multi-dose bottle or remove the single-use container from the original foil pouch until immediately prior to use. Tilt the head back slightly and pull the lower eyelid down with the index finger to form a pouch. Cetirizine is a known human metabolite of hydroxyzine, and levocetirizine is an enantiomer of cetirizine. Renal failure, renal impairment In patients with moderate to severe renal impairment (CrCl 31 mL/minute or less) or renal failure, dosage reduction of oral cetirizine is recommended; cetirizine is not appreciably removed during dialysis. No dosage adjustment of cetirizine injection for acute urticaria is required in patients with moderate and severe renal impairment and in patients on dialysis; however these patients should be monitored for antihistaminic side effects. There are no adequate or well-controlled studies with the use of cetirizine during human pregnancy. Animal studies do not reveal a risk for teratogenesis, even at doses greatly exceeding the maximum recommended daily human dose on mg/m2 basis; however, animal studies are not always predictive of human response. The British Society for Allergy and Clinical Immunology recommends cetirizine at the lowest dose as a preferred antihistamine in breast-feeding women. No safety differences have been noted in clinical use for elderly (65 years and older) vs.
In controlled clinical trials using the recommended dose of one tablet every 12 hours allergy testing waco tx generic benadryl 25mg overnight delivery, the incidence of reported adverse events was similar to allergy treatment alternative medicine generic 25 mg benadryl with amex those reported with placebo allergy forecast east texas purchase benadryl 25 mg mastercard, with the exception of insomnia (16%) and dry mouth (14%) allergy free cats benadryl 25mg amex. In addition to those adverse events reported above (?2%), the following less frequent adverse events have been reported in at least one patient treated with loratadine; pseudoephedrine sulfate 12 hour extended release tablets. Autonomic Nervous System: Abnormal lacrimation, dehydration, flushing, hypoesthesia, increased sweating, mydriasis. Body as a Whole: Asthenia, back pain, blurred vision, chest pain, conjunctivitis, earache, ear infection, eye pain, fever, flu-like symptoms, leg cramps, lymphadenopathy, malaise, photophobia, rigors, tinnitus, viral infection, weight gain. Cardiovascular System: Hypertension, hypotension, palpitations, peripheral edema, syncope, tachycardia, ventricular extrasystoles. Central and Peripheral Nervous System: Dysphonia, hyperkinesia, hypertonia, migraine, paresthesia, tremors, vertigo. Gastrointestinal System: Abdominal distension, abdominal distress, abdominal pain, altered taste, constipation, diarrhea, eructation, flatulence, gastritis, gingival bleeding, hemorrhoids, increased appetite, stomatitis, taste loss, tongue discoloration, toothache, vomiting. Psychiatric: Aggressive reaction, agitation, anxiety, apathy, confusion, decreased libido, depression, emotional lability, euphoria, impaired concentration, irritability, paroniria. Respiratory System: Bronchitis, bronchospasm, chest congestion, coughing, dry throat, dyspnea, epistaxis, halitosis, nasal congestion, nasal irritation, sinusitis, sneezing, sputum increased, upper respiratory infection, wheezing. Skin and Appendages: Acne, bacterial skin infection, dry skin, eczema, edema, epidermal necrolysis, erythema, hematoma, pruritus, rash, urticaria. Urinary System: Dysuria, micturition frequency, nocturia, polyuria, urinary retention. In these studies, the incidence of adverse events reported with loratadine; pseudoephedrine sulfate 24 hour extended release tablets was similar to those reported with twice-daily (q12h) 120 mg sustained-release pseudoephedrine alone. Adverse events did not appear to significantly differ based on age, sex, or race, although the number of nonwhites was relatively small. In addition to those adverse events reported above, the following adverse events have been reported in fewer than 2% of patients who received loratadine; pseudoephedrine sulfate 24 hour extended release tablets. Autonomic Nervous System: Altered lacrimation, flushing, increased sweating, mydriasis, thirst. Body as a Whole: Abnormal vision, asthenia, back pain, chest pain, conjunctivitis, earache, eye pain, facial edema, fever, flu-like symptoms, leg cramps, lymphadenopathy, malaise, rigors, tinnitus. Central and Peripheral Nervous System: Convulsions, dysphonia, hyperkinesis, hypertonia, migraine, paresthesia, tremor. Gastrointestinal System: Abdominal distension, altered taste, constipation, diarrhea, dyspepsia, flatulence, gastritis, stomatitis, tongue ulceration, toothache, vomiting. Respiratory System: Bronchospasm, dyspnea, epistaxis, hemoptysis, nasal congestion, nasal irritation, pleurisy, pneumonia, sinusitis, sputum increased, wheezing. Urinary System: Oliguria, micturition frequency, urinary retention, urinary tract infection. Additional adverse events reported with the combination of loratadine and pseudoephedrine include abnormal hepatic function, aggressive reaction, anxiety, apathy, confusion, euphoria, paroniria, postural hypotension, syncope, urticaria, vertigo, weight gain. There have been postmarketing reports of mechanical upper gastrointestinal tract obstruction and esophageal perforation in patients taking a previously marketing formulation of loratadine; pseudoephedrine sulfate 24 hour extended release tablets. In some, but not all, of these cases, patients have had known upper gastrointestinal narrowing or abnormal esophageal peristalsis. Additional Adverse Events for 24 Hour Extended Release Tablets Only: Abdominal distress, altered micturition, bronchitis, decreased libido, dry skin, hypoesthesia, impaired concentration, impotence, increased appetite, peripheral edema, rash, and upper respiratory infection. Headache, drowsiness, tachycardia, palpitation, pressor activity, and cardiac arrhythmias have been reported. Sympathomimetic drugs have also been associated with other untoward effects, such as fear, anxiety, tenseness, tremor, hallucinations, seizures, pallor, respiratory difficulty, dysuria, and cardiovascular collapse. At high doses, subjects commonly experience an elevation of mood, a sense of increased energy and alertness, and decreased appetite. In addition to the marked euphoria, the user experiences a sense of markedly enhanced physical strength and mental capacity. With continued use, tolerance develops, the user increases the dose, and toxic signs and symptoms appear. The most common adverse reactions, occurring in greater than or equal to 5% of the patients, are listed in Table 1. Prednisolone tapering scheme: either 40 mg in week 1 to 2, thereafter tapering with 5 mg per week; or 40 mg in week 1 to 2, 30 mg in week 3 to 4, thereafter tapering with 5 mg per week. The incidence of signs and symptoms of hypercorticism reported by active questioning of patients in 4 of the 5 short-term clinical trials are displayed in Table 2. Prednisolone tapering scheme: either 40 mg in week 1-2, thereafter tapering with 5 mg/week; or 40 mg in week 1 to 2, 30 mg in week 3 to 4, thereafter tapering with 5 mg/week. Since then, his symptoms have been well controlled with intermittent chemotherapy despite his known liver and multiple spinal metastases. The pain is moderate in severity and described as aching and constant in his neck, with intermittent, sharp, shooting pain through his left upper back and shoulder. You change his dexamethasone to morning dosing and prescribe 25 mg of trazodone orally once daily at bedtime to help with Mr C. Because side effects accumulate over the long term, corticosteroids are best used for short-term therapy (1 to 3 weeks). For cases in which corticosteroids are used in the long term, their use should be monitored closely. Common side effects of dexamethasone Most frequent side effects include the following: increased appetite or weight gain proximal muscle weakness insomnia gastrointestinal side effects psychiatric side effects, such as delirium, depression, anxiety, and psychosis osteoporosis with long-term use Less frequent side effects include the following: infections hyperglycemia Cushing syndrome Life-threatening side effects include the following: gastrointestinal bleeds thromboembolism Data from Walsh et al,9 Pereira,11 and Sturdza et al. Results of repeat magnetic resonance imaging show no spinal cord impingement, but there is further extension of his bony metastases. Their widespread use as analgesic adjuvants for bony, visceral, and neuropathic pain is widely supported by expert opinion. Corticosteroids reduce pain by reducing inflammation and edema associated with tumours and de polarization of damaged nerves. A retrospective observation of corticosteroid use at the end of life in a hospice. 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Other medical conditions, such as appendicitis, kidney diseases, pelvic infections, and ovarian disorders, among others, can cause low back pain. The most important aspect of back pain is how it impacts your ability to function in your daily life. Medications: The choice of medication depends on whether the pain is muscle and bone pain, nerve pain, or a mixture of both. These do not treat the underlying cause, but rather mask the sensation of pain Muscle relaxants, such Flexeril or Soma. However, they must be used with extreme caution, especially if they are used for longer a week. Cold or ice applied to your back can reduce inflammation and swelling by constricting blood vessels. Some studies show that heat is an effective approach for acute nonspecific back pain. Injections: Anesthetics, steroids, or narcotics into soft tissues, joints, and other areas can be injected in and around your spine. Surgery: There are several different types of back surgery, depending on the underlying problem causing the back pain: Diskectomy removes the herniated portion of a disk to relieve pressure on a nerve. Laminectomy removes the lamina (bony structure) that overlays the spinal canal to relieve nerve pressure caused by spinal stenosis. Exercise and Physical Therapy Physical activity plays a strong role in recovering from back pain and particularly in helping to prevent future pain and loss of function. Exercise programs are individualized because people have different levels of pain and differing injuries that caused the pain initially. Improving the strength, endurance, and function of your back helps minimize the chance of recurrence of back pain. Extra weight throws off your posture and makes it difficult to properly align your body for a good sleep. What are some integrative therapies and healing practices to consider for low back pain?
Patients should be screened for latent or active tuberculosis before receiving infliximab allergy cure benadryl 25 mg on line. Physicians who use these medications should clearly understand their benefits and risks so they can provide the best possible care allergy forecast va benadryl 25mg low cost. Learn answers to allergy medicine loratadine generic buy discount benadryl 25mg line frequently asked questions about allergy treatments and medications allergy medicine nasacort buy benadryl 25 mg overnight delivery. Answer: Claritin is loratadine, which is metabolized in the liver to produce desloratadine, which is Clarinex. Cromolyn is available over the counter with the name Nasalcrom, and it is effective but must be used four times a day or more. Answer: Nasal steroids - in the usual doses - can be tolerated for long periods of time by most people. These effects may range from cracking and minor bleeding in the nose to a very small but measurable increased risk of cataracts. This is rare with a nasal steroid but the treatment is the same as with an inhaled steroid. My questions: Is itchy skin a typical allergic response and what can I do to stop the itching? Answer: Singulair is a prescription medicine approved to help control asthma in adults and children as young as 12 months and to help relieve the symptoms of seasonal allergies in adults and children as young as 2 years. Answer: Patients who have had systemic reactions to stings by vespids (honey bee, wasp, hornet, yellow jacket) or ants are at risk for allergic reactions that may be life threatening. These preparations are available by prescription only but can be life saving and should be carried by all patients with a history of systemic responses to these insects. There are also over-the-counter antihistamine and decongestant combinations that help with sinus drainage. Older antihistamines, such as pyribenzamine and benadryl, are probably the safest to use in pregnancy. Always inform your doctor if you are pregnant, planning a pregnancy or breastfeeding before using any medicine. Great caution should be used with all of these medications and certainly not before a thorough consultation with your doctor. His eyes are not red or watery, but at night he has trouble breathing from congestion. However, currently available clinical tests are not very reliable in making the diagnosis. Studies of Alzheimer’s disease suggest that neuroinflammation [1] or deranged brain wound healing [2] may be responsible for some cases. Such minute amounts of steroid in the brain presumably have a tiny or negligible effect. Indeed, another placebo controlled study showed no effect at all on Alzheimer’s disease of low dose oral prednisone after one year [9]. MedWatch was organized in 1993 to collect data regarding adverse events in healthcare. The latter group is required by law to submit the mandatory form immediately upon discovery of a product malfunction. Printable mail-in forms are available as an alternative to the online submission system [11]. The adverse event may have been related to the underlying disease being treated, perhaps caused by another drug being taken concurrently, or something else. Machine-readable data from MedWatch, including adverse drug reaction reports from manufacturers, are part of a public database. The most common other conditions in patients who reported Alzheimer’s disease are listed in Table 2. Hay fever patients’ use of nasal glucocorticoids might be lessening their risk of Alzheimer’s disease and functioning as a treatment in early cases. Another analysis found no effect of hay fever [18], but subjects’ use of anti-allergy anticholinergics, such as diphenhydramine, may have confused the results by raising risk of Alzheimer’s disease [19]. Both pregnenolone and progesterone arrive in the brain after nasal administration [20]. While glucocorticoids are essential for an effective stress response, their oversecretion was originally hypothesized to contribute to age-related hippocampal degeneration. This problem might be addressed by prescription records (or company sales records) indicating how many took the drug. Another problem in our analysis is that those who reported adverse effects were likely also taking other medications, which may be associated with Alzheimer’s disease, either increasing or decreasing the risk (some because they treat a disease that is a risk factor for Alzheimer’s disease). This problem might be addressed more systematically by a big data analysis of MedWatch to seek drugs negatively associated with Alzheimer’s disease. Dementia has been listed as a side effect of atorvastatin (and other statins), but might represent the confluence of two common disorders: hypercholesterolemia and dementia (which is not the same as Alzheimer’s disease). These phenomena could account for part of the observed lower incidence of Dementia Alzheimer’s type reports in patients using Flonase®. Nevertheless, long term use of oral non-steroidal anti-inflammatory drugs is linked with reduced risk of developing Alzheimer’s disease [26]. That is, there is an initial event, and the brain response is what causes the dementia which we call “Alzheimer’s disease. In summary, data from MedWatch presented here suggest that fluticasone propionate administered intranasally might have a similar preventive effect to ibuprofen. What data supports these claims, and is it inhalers themselves or the steroids dispensed by some of these devices that are the problem? Air quality decreases due to pollution trapping, fuels like wood, coal and paraffin are burnt for warmth and influenza (flu) infection rates surge. Many people will consult doctors for relief from their tight chests and shortness of breath. Enter inhalers: the solution to the problem of how to administer medication directly to the lungs. Because so many people need inhalers we should all be worried by news reports published by the Star newspaper in South Africa claiming that studies have shown that “inhalers can damage lungs”. The connection between lung damage and inhaler use is never clearly explained in the Star’s version of the report. Instead it refers to the effect of inhaled corticosteroids (a class of medication used to suppress inflammation and the immune system) on the lungs, and concern that these drugs leave users more susceptible to infections. We contacted the Star and the original Mail Online journalist to ask which study they were reporting on. Inhalers have been tested for safety Inhalers are a drug delivery mechanism and are used to administer a variety of medications. A blanket statement like “inhalers can damage lungs” is like saying “eye drops can damage eyes” or “creams can damage skin”. Metered dose inhalers consist of a metal canister, which contains both the drug and the substance that carries the drug — the propellant. The standard propellant used in modern inhalers has been shown to be so safe that dosages 200 times and upwards of the expected human exposure have been found to be non-toxic. This is in part because most of the inhaled propellant is exhaled again almost immediately. They contain a mixture of the active medication (in powder form) and a stabilising agent (typically lactose). The stabilising agent must be both safe to inhale and prevent clumping of the medication, so that the medication is delivered evenly to the lungs. This substance must also be non-irritating and be able to be broken down by the body or swept up and out by the cells lining the airways. One of the earliest reviews was an extensive series of animal studies on rats, dogs, monkeys and macaques. Other studies have investigated if dry powder inhalers are more dangerous than metered dose inhalers. A Brazilian study showed that there was no difference in side effects or efficacy of drug delivery. If research shows that inhalers are safe, that leaves one final avenue of investigation. Corticosteroids — a type of steroid — are part of the typical treatment in the management of asthma.
Your inhaler contains such a low dose of steroids that it will not make you put on weight allergy symptoms and headaches cheap benadryl master card. On the other hand allergy kingdom cheap benadryl online amex, having your asthma out of control itself can lead to allergy nose discount benadryl growth problems allergy group generic 25 mg benadryl with visa. About Sports Q: I love to play basketball, but how can I get good at sports when I have asthma, and need to take so many breaks to catch my breath? Right now you need to build up your confidence and accept yourself as you are, with or without asthma. I started it on the first day of my period, then had some light spotting and then my period stopped. I did that once before and I bleed for almost a month until I started my next period. I thought I should stop taking Yasmin entirely and for the last few days I have had the worst period in my life and the clots are awful. About 2 or 3 months ago, my pharmasist gave the generic form of yaz which is gianvi. I had the depo provera injection about six weeks ago and started getting spotting after sex 9 days ago. But I too think my body has just gotten used to the amount of hormones or I should try taking it at a different time instead of night. If your period was really irregular before taking trinessa, your body could still be trying to be irregular. Hi, I been on the depo shot for 5 years I last took my depo shot july 5th andd my doctor said to come back in 3 months. If you miss three active pills in a row in Week 1, 2, or 3, throw out the rest of the pack and start a new pack on the same day if you are a Day 1 starter. The spotting was semi-light with a pinkish hue, now it has some brown areas when I wipe. I just tried skipping my bleeding for the first time with the triphasic pill(Ortho Tri-Cyclen). You say that there are no ill health effects but if the bleeding is heavy and continues for a while anemia is an issue along with fatigue. I had a similar experience with Levlen (I was on it since high school), however instead of going on a stronger dosage, I asked my Dr to give me something weaker - so I went on Yasmin for a while. I found Yasmin worked for me for a couple of years but then when I started to get spotting again. I went off the Nuva Ring two months ago - had a regular period two weeks ago and now I am bleeding again. Yhe first few weeks were fine but now im very very light stopping this has bn going on for nearly a month now my boyfriend is getting so annoyed at me.... Antibiotics Might Lower Effectiveness of Birth Control Pill There are many brands and forms of this medicine available. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: Eye irritation. Ointment: Gently pull down the lower lid and squeeze in how much the doctor told you to use. General drug facts If your symptoms or health problems do not get better or if they become worse, call your doctor. Microscopic Colitis is an inflammatory bowel disease that affects the large bowel (colon and rectum) and was first recognized by doctors 40 years ago. The long term outlook for sufferers of Microscopic Colitis is good with a recent study showing that more than three out of four people achieve long term remission from the condition. This web page provides a brief overview of Microscopic Colitis, including diagnosis, possible causes, and treatments. In Collagenous Colitis, a thicker than normal layer of a protein called collagen develops in the lining of the colon and there may also be increased numbers of lymphocytes. Microscopic Colitis affects the large bowel (the last part of the digestive system) which includes the colon and the rectum. Chemical imbalances in the digestive system can also occur causing yet more fluid to build-up in the colon. The main symptom of Microscopic Colitis is chronic (ongoing) watery diarrhea, which may begin very suddenly. Around one-quarter of people are diagnosed before the age of 45 years old, and although rare, Microscopic Colitis has also been found in children. Both Lymphocytic Colitis and Collagenous Colitis affect more women than men, although the gender differences are greater for Collagenous Colitis. The cause of Microscopic Colitis is unknown, but studies suggest there is not one single cause, but a combination of several, setting off an inflammatory response. This idea is supported by people with Microscopic Colitis having a greater number of other autoimmune conditions than the general population. Several recent studies have demonstrated links between cigarette smoking and Microscopic Colitis, with one study showing a three fold increased risk in current smokers and a two fold increased risk in past smokers. On average, smokers develop Microscopic Colitis 10 - 14 years earlier than non-smokers. Studies show that people with Microscopic Colitis are 50 times more likely to have celiac disease than the general population. Although a few cases have been reported, the number is very low, so it could just be a chance association. There are similarities between the features of each condition and thorough tests are necessary to reach the correct diagnosis. Some studies suggest people with Microscopic Colitis have a lower risk of developing bowel cancer than people who do not have the condition. Over one-third of people with Microscopic Colitis find that their symptoms stop without the need for treatment. If you are taking any of the drugs mentioned previously as possible triggers for Microscopic Colitis, then you may be asked to change or decrease the medication. If none of the steps mentioned above has improved your symptoms, you might need to take medication for your Microscopic Colitis. The main goal of treatment is to achieve clinical remission (freedom from symptoms) and improve the quality of life. While more drug studies have been undertaken in Collagenous Colitis than Lymphocytic Colitis, it is generally felt there is no need to treat these conditions differently. Some guidelines have suggested treatment should be stopped after two months to identify the third of patients who will not require longer treatment. This allows anyone who relapses to continue on maintenance treatment with budesonide. The latest studies of maintenance treatment with budesonide suggest low doses are effective. Using a low dose is important because despite budesonide having fewer side effects than other steroids (due to its local effect and it being more efficiently broken down by the liver), it can still cause problems. Bone loss, for example, while reduced with budesonide, is not completely eliminated. In comparison to budesonide, other steroids, such as prednisolone, have a more limited role in Microscopic Colitis. Around one in eight people with severe Microscopic Colitis do not respond to budesonide, leading to the need for alternative treatments. In small studies azathioprine (or mercaptopurine) brought on remission in Microscopic Colitis and reduced the need for steroids. But another study suggested long term use in Microscopic Colitis may lead to patients developing intolerance and having to stop treatment. While older publications have reported surgical approaches can successfully treat severe Microscopic Colitis, the development of more effective medications means surgery is now rarely required. There is only limited evidence on foods that may affect people with Microscopic Colitis. Generally, the best thing to do is to eat a nutritious and balanced diet to maintain your weight and strength and to take sufficient fluids to stop you becoming dehydrated. It may also help to reduce your intake of caffeine and artificial sugars as they are known to draw fluid into the bowel that may aggravate diarrhea. You could also consider avoiding milk products as it may be possible that intolerance to lactose in milk might be making your diarrhea worse.
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