Ischemic colitis is a known complication of cocaine and amphetamine abuse. Less appreciated is ischemic colitis associated with drug therapy or the use of herbal remedies.
Drugs implicated in causing ischemic colitis include:
(1) alostetron (5HT-3 antagonist) for irritable bowel syndrome
(2) anticoagulant
(3) antihypertensive agent
(4) cancer chemotherapeutic agents
(5) ibandronate (a bisphosphonate)
(6) immunosuppressive agent
(7) interferon
(8) NSAID
(9) olanzapine or clozapine
(10) phentermine
(11) pseudoephedrine
(12) rofecoxib (selective cyclo-oxygenase-2 inhibitor)
(13) steroid or sex hormone
(14) sumatriptan succinate (5HT-1, serotonin-1 receptor agonist)
(15) tegaserod (serotonin 5-HT4 receptor partial agonist)
(16) TNF-alpha inhibitor
Herbal therapy and dietary supplement:
(1) bitter orange (Citrus aurantium): synephrine (sympathomimetic alkaloid
(2) ergotamine
(3) NO-Xplode (performance enhancing supplement)
Diagnosis would require:
(1) onset of ischemic colitis after starting implicated agent
(2) exclusion of alternative explanation (arteriosclerosis, drug abuse, emboli)
(3) reversal on agent discontinuation
(4) recurrence on re-exposure (rarely done intentionally)
Problems in diagnosis:
(1) drug interactions
(2) concomitant risk factors arteriosclerosis and ischemic colitis
