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Ulcerative colitis and nicotine

I’ve got ulcerative colitis and have heard that nicotine has been usedto treat it, but I don’t smoke. In fact, I hate cigarette smoke. Whatdo you suggest?

by Lin-Nam Wang

Ulcerative colitis (CNRI/SPL)

Question

I’ve got ulcerative colitis and have heard that nicotine has been used to treat it, but I don’t smoke. In fact, I hate cigarette smoke.

What do you suggest?

Answer

A higher incidence of ulcerative colitis in non-smokers compared with smokers and anecdotal reports of patients who have given up smoking suffering more frequent or greater symptoms led to the suggestion that nicotine could be a potential treatment for this autoimmune disease.

According to one study, smokers are about eight times less likely to have ulcerative colitis than non smokers.1 These factors led to studies on the use of nicotine to treat the condition.

Although the patient is concerned about smoking, many of the studies looked at transdermal nicotine. The sorts of doses of nicotine used were between 15 to 25mg/day and the outcomes looked at included abdominal pain, stool frequency and faecal urgency.

A Cochrane review examined the available evidence and concluded that transdermal nicotine is better than placebo in the treatment of active ulcerative colitis.2

However, patients were more likely to suffer side effects, which included nausea, headache and dizziness. Patches can also cause skin reactions.

In addition, the reviewers concluded that no significant advantage over conventional therapy (eg, steroids and mesalazine) was identified. Moreover, nicotine patches are not licensed for this indication so should not be sold for ulcerative colitis.

Suggested mechanisms of action for nicotine in treating the disease include increasing the adherent surface mucus in the intestine (which is reduced in sufferers) and inhibiting the inflammatory response. However, until further evidence is available, nicotine as an alternative treatment for ulcerative colitis cannot be recommended.

A search of PubMed shows that in the 1990s, researchers were working on an oral nicotine capsule that would release the drug in the colon and as recently as 2008, a paper looking at the use of nicotine enemas for active Crohn’s colitis was published.

In patients less averse to cigarette smoking than this one, the pharmacist might also consider emphasising that the many serious health risks of smoking would far outweigh any possible benefits to colitis.

The patient could be signposted to the National Association for Colitis and Crohn’s Disease (tel 0845 130 2233; e-mail nacc@nacc.org.uk).

 

If you have been asked a question that you would like to share with other Learning & Development readers, e-mail it with your suggested answer to: LandD@pharmj.org.uk

 

References

1. Bandolier. Transdermal nicotine for ulcerative colitis

2. McGrath J, McDonald JW, MacDonald JK. Transdermal nicotine for induction of remission in ulcerative colitis. Cochrane Reviews

Citation: The Pharmaceutical Journal URI: 10046943

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