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Intestinal Radiation Injury Medication

  • Author: Rajeev Vasudeva, MD; Chief Editor: BS Anand, MD  more...
Updated: Sep 04, 2015

Medication Summary

The treatment of acute injury varies depending on the symptoms, and treatment of chronic injury varies depending on the location of the injury.



Class Summary

Used to treat nausea and vomiting related to acute radiation enteritis.

Ondansetron (Zofran)


Selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin), and complete body radiotherapy. Also beneficial in reducing the frequency of diarrhea by delaying intestinal transit.



Class Summary

Used to treat diarrhea associated with acute radiation enterocolitis.

Loperamide (Imodium)


Acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. Prolongs movement of electrolytes and fluid through the bowel lumen and increases viscosity and loss of fluids and electrolytes.

Diphenoxylate and atropine (Lomotil, Lonox)


Drug combination that consists of diphenoxylate, which is a constipating meperidine congener and a subtherapeutic dose of atropine to discourage misuse. Inhibits excessive GI propulsion and motility.

Cholestyramine (Questran)


Forms a nonabsorbable complex with bile acids in the intestine, which, in turn, inhibits enterohepatic reuptake of intestinal bile salts. Decreases diarrhea by preventing bile salt malabsorption.

Sucralfate (Carafate)


An aluminum-hydroxide complex of sulfated sucrose, which forms a protective barrier at the site of ulceration due to radiation. Binds bile acids and helps to treat diarrhea from secondary bile acid malabsorption. Effective when administered PO as a prophylactic agent in preventing acute and chronic radiation injury. Studies using enemas for the treatment of radiation proctitis have shown promising short-term results. No dosing standards exist, and doses used in studies vary from 1 g PO q4-6h during treatment and for another 3-4 wk thereafter.


Topical corticosteroids

Class Summary

Used to treat symptoms related to radiation proctitis.

Hydrocortisone (Cortenema)


Retention enema. An adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity. Used for its anti-inflammatory properties and is effective in radiation proctitis.


Topical formalin therapies

Class Summary

Used for intractable bleeding from radiation proctitis.

Formaldehyde topical (Formalin 4%)


Direct mucosal contact allows rectal bleeding to cease.

Contributor Information and Disclosures

Rajeev Vasudeva, MD Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD is a member of the following medical societies: American College of Gastroenterology, Columbia Medical Society, South Carolina Gastroenterology Association, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, South Carolina Medical Association

Disclosure: Received honoraria from Pricara for speaking and teaching; Received consulting fee from UCB for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS is a member of the following medical societies: American Academy of Clinical Toxicology, American Society for Gastrointestinal Endoscopy, American Federation for Clinical Research, American Association for the Study of Liver Diseases, American College of Forensic Examiners Institute, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association

Disclosure: Nothing to disclose.

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Intestinal radiation injury. Characteristic mucosal changes observed in radiation proctitis with multiple telangiectasias.
Intestinal radiation injury. Friability and oozing of blood from atrophic-appearing mucosa due to radiation.
Intestinal radiation injury. Appearance of mucosa after therapy with bipolar circumactive probe (BICAP) probe.
This slide illustrates disorderly crypts, fibrosis of lamina propria, and vascular dilatation, all of which are characteristic of colonic injury due to radiation. Courtesy of Ronald Burns, MD, Palmetto Richland Memorial Hospital, Columbia, SC.
A deep rectal ulcer from prostate cancer radiation years ago. Patient presented with significant rectal bleeding.
After 6 months of treatment with daily Canasa (5-ASA) suppositories.
Retroflexed view of the same radiation induced ulcer after 6 months of treatment.
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