Table 1.

Different Medication Use for the Treatment of Toxic Megacolon

Medication	Indications	Mechanism of Action/Dosages	Therapeutic Benefits/Risks/Complications
Sulfasalazine/5-ASA compounds	-In IBD related Toxic megacolon not as first line, after attack resolves	-Anti-inflammatory effects	-No enough data supporting beneficial use in IBD related toxic megacolon, it can be used after initial attack resolves
Glucocorticoids	-First-line therapy for all patients with IBD-related toxic megacolon	-Decreases diameter of colon by reducing nitrous oxide synthetase	-Not associated with risk of colonic perforation
	-Methylprednisolone due to its lower sodium retaining and potassium wasting properties, while other clinicians prefer prednisolone since the parenteral dose is equal to the oral dose	-Hydrocortisone 100 mg IV every 6 to 8 hours -Methylprednisone 60 mg daily for 5 days37,38
Cyclosporine	If no response to Glucocorticoids within 3 days	-Inhibits T-lymphocyte function that is essential for the propagation of inflammation	-Cyclosporine should be reserved for those who cannot tolerate infliximab and there is only evidence for its effectiveness in ulcerative colitis, not Crohn’s disease
		-Rapid response 4 mg/kg per day; 82% with clinical improvement with possibility of avoiding colectomy39	-Cyclosporine better to be avoided in elderly patients with significant co-morbid conditions as well as patients in whom colectomy is likely to be necessary in near future
Infliximab	If no response to Glucocorticoids within 3 days	-Blocks the action of TNF-α by preventing it from binding to its receptor in the cell, but it also causes programmed cell death of TNF-α-expressing activated T lymphocytes that mediate inflammation -Infliximab 5 mg/kg (2 or 3 infusions)40	-Effective as rescue therapy for severe steroid refractory colitis in up to 70% of instancing -Clinical response usually occurs within 3 to 7 days of treatment - Infliximab also appears to induce a long-term remission comparable to that seen with cyclosporine