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Probable ischemic colitis caused by pseudoephedrine with tramadol as a possible contributing factor
Amelia A Traino1, Nick A Buckley, Mark L Bassett
1The Prince of Wales Hospital, Randwick, Sydney, Australia.
The Annals of Pharmacotherapy
|November 4, 2004
Summary
Pseudoephedrine in over-the-counter decongestants may cause ischemic colitis, even at recommended doses. Patients should cease use if abdominal pain occurs, especially when taking tramadol concurrently.
Area of Science:
- Gastroenterology
- Pharmacology
- Clinical Medicine
Background:
- Ischemic colitis is a clinical syndrome resulting from reduced blood flow to the colon.
- Over-the-counter (OTC) medications can have significant systemic effects, sometimes leading to adverse events.
- Pseudoephedrine is a common sympathomimetic amine found in many OTC cold and allergy medications, known for its vasoconstrictive properties.
Observation:
- A 46-year-old male developed acute ischemic colitis.
- The patient self-medicated with an OTC oral decongestant containing pseudoephedrine (240 mg/day) for one week.
- Concurrent use of tramadol (150 mg/day) for chronic back pain was noted.
Findings:
- Clinical, endoscopic, and histologic findings were consistent with acute ischemic colitis.
- Naranjo probability scale indicated pseudoephedrine as a probable cause.
- The patient experienced a complete recovery after cessation of the medication, with no other causative factors identified.
Implications:
- Pseudoephedrine, even at standard doses, can cause vascular insufficiency due to intense vasoconstriction.
- Concurrent use of pseudoephedrine and tramadol may potentiate adrenergic vasoconstriction, increasing the risk of ischemic colitis.
- Healthcare providers should advise patients to avoid prolonged or intensive use of pseudoephedrine-containing medications and to discontinue use if ischemic symptoms arise.