Ask a doctor on the topic of Internal medicine

Ulcerative colitis - antibiotics and pain medication after hair transplantation.

August 19, 2020 | 30,00 EUR | answered by Dr. med. Frauke Gehring

Dear specialist,

I have ulcerative colitis and I am currently mostly or entirely in remission, thanks to Entyvio. I am considering getting a hair transplant. I will need a painkiller (Ibuprofen) for the evening after the procedure and for the following two days. However, as a UC patient, I am advised not to take non-steroidal anti-inflammatory drugs. Paracetamol was deemed okay by my gastroenterologist in the past, although this information is outdated. After some research, I found that Tramadol, Tilidin, or Metamizol could also be options. Which painkiller can I safely take and in what dosage? Additionally, I am supposed to take Azithromycin the morning after the surgery and the day after that (1 tablet before the painkiller). I am hesitant to take antibiotics due to concerns about my gut flora. Do you think this is safe? What is your opinion on skipping the antibiotics altogether, especially if my head is completely shaved for the procedure? I also occasionally take PrEP (pre-exposure prophylaxis against HIV) as needed, which I will not need during this time. Thank you!

Best regards,

Questioner

Dr. med. Frauke Gehring

Hello,

As Paracetamol irritates the intestines less, that would be a good alternative, another option would be Metamizol, which in rare cases can have strong side effects (allergic agranulocytosis). I would only take that if stronger pain occurs.

Paracetamol up to 4x 2 tablets. Metamizol as well.

I am not a big fan of prophylactic Azithromycin, as it stays in the body for 10 days (!). Perhaps you could agree on 3 days of Amoxicillin, which is more tolerable for the intestines. If you skip it, an infection could endanger the transplants.

I wish you all the best!

Sincerely, Dr. Gehring