Understanding IBD Medications and Side Effects
Medication information is up to date at the time of printing. Due to rapid advances and new findings, there may be changes to this information over time. You should always check with your doctor to get the most current information. View the fact sheet called "Recently Approved Treatments" for a list of new medications.
If you or someone you know has just been diagnosed with Crohn’s disease or ulcerative colitis, you may feel a bit overwhelmed by the news. In fact, you may not have even heard of these illnesses before. But now that you have, you will want to learn as much as possible about them—including which medications can help control the diseases. To learn more about medications, download the brochure, Understanding IBD Medications and Side Effects.
Crohn’s disease and ulcerative colitis belong to a group of conditions known as inflammatory bowel diseases, or IBD. These disorders affect the gastrointestinal (GI) tract, the area of the body where digestion takes place. As the name implies, the diseases cause inflammation of the intestine. When a part of the body is inflamed, it becomes red and swollen. Sores, or ulcers, may also form within the walls of the intestine. The ongoing inflammation leads to symptoms that may already be familiar to you: abdominal pain, cramping, diarrhea, rectal bleeding, and fatigue. For some people, symptoms are not just restricted to the GI tract. They may experience signs of IBD in other parts of the body, such as the eyes, joints, skin, bones, kidney, and liver. These are referred to as extraintestinal manifestations of IBD, because they occur outside of the intestine.
Although Crohn’s disease and ulcerative colitis share a lot of symptoms, they do have some marked differences. While inflammation related to Crohn’s disease may involve any part of the GI tract from the mouth to the anus (including the esophagus, stomach, small intestine, and large intestine), ulcerative colitis is limited to just the large intestine (including the colon and rectum). Another distinguishing feature of ulcerative colitis is that it starts in the rectum and extends from there in a continuous line of inflammation. In contrast, Crohn’s disease may appear in “patches,” affecting some areas of the GI tract while leaving other sections in between completely untouched. These are known as “skip” areas. These differences are important for deciding whether inflammation of the intestinal tract is from Crohn’s disease or ulcerative colitis.
Although you may have never heard of these diseases, approximately 1.4 million American adults and children suffer from Crohn’s disease or ulcerative colitis. Most people develop these diseases between the ages of 15 and 35. The number of newly diagnosed people has exploded over the last 50 years. The exact reasons for this increase are unknown. To date, there is no known cause of or cure for Crohn’s disease or ulcerative colitis, and that’s what makes the Crohn’s & Colitis Foundation of America’s (CCFA) research so critical. CCFA has pioneered the field of research into these difficult digestive diseases for nearly a half-century. Some of our major projects have included human genome (study of genes associated with IBD), microbiome (study of bacterial species), and genetic research.
To date, there is no known cause of or cure for IBD, but fortunately there are many effective treatments to help control these diseases.
The three main goals of treatments for IBD are:
- Achieving remission (defined as the absence of symptoms).
- Maintaining remission
- Improving quality of life
These goals may be achieved either with a combination of over-the-counter and prescription medications, or surgery depending on each individual case. When considering medication options, you should remember the following key points:
- Symptoms of these long-term diseases may range from mild to severe and may include, but are not limited to, diarrhea, abdominal cramping, nausea, pain, rectal bleeding, and fever.
- People will go through periods in which the illness is active and is causing symptoms. Such periods are known as flares. These episodes are usually followed by times of remission. Remission occurs when symptoms either disappear completely or lessen considerably and good health returns. These disease-free periods can last months or even years.
Because each person with IBD is different, the treatment used to control his or her illness is unique, as well. There is no “one-size-fits-all” approach. Doctors will customize treatment to the individual’s needs based on the type and severity of symptoms. It may be given in different dosages, formulations, and for different lengths of time.
- Medications can be given in oral form (by mouth), intravenously (through a vein), or subcutaneous (by injection under the skin). Topical therapies are administered rectally, as suppositories, enemas, creams, and ointments.
- It is important to keep in mind that a person’s therapeutic needs may change over time. What works at one point during the illness may not be effective during another stage. It is important for the patient and doctor to discuss thoroughly which course of therapy is best—bearing in mind that a combination of therapies may be the optimal treatment plan.
Over-the-Counter (OTC) Medications
Prescription medications reduce intestinal inflammation and form the core of IBD treatment. Even so, these important prescription medications may not eliminate all of your symptoms. Naturally, you may want to take over-the-counter medications in an effort to feel better. Before doing so, speak with your doctor, or other healthcare professional, as sometimes these symptoms may indicate a worsening of the inflammation that may require either hospitalization or a change in your prescription IBD medication.
Other times these symptoms do not reflect a worsening of the condition and can be treated with over-the-counter medications. Your doctor may recommend loperamide (Imodium®) to relieve diarrhea, or anti-gas products for bloating. To reduce joint pain and fever, your doctor may recommend acetaminophen (Tylenol®) or non-steroidal anti-inflammatory drugs (NSAID)—such as aspirin, ibuprofen (Advil®, Motrin®), or naproxen (Aleve®). NSAIDs will work to alleviate joint symptoms but can irritate the small intestine or colon, thus promoting inflammation, so these should be used with great care. Make sure that you follow instructions with all OTC products, but again, speak with your healthcare professional first before you take any of these medications.
Some medications used to treat Crohn’s disease and ulcerative colitis have been around for years. Others are more recent breakthroughs. The most commonly prescribed medications fall into five basic categories:
- Aminosalicylates:These include aspirin-like compounds that contain 5-aminosalicylic acid (5-ASA). These drugs, which can be given either orally or rectally, do not suppress the immune system but decrease inflammation at the wall of the intestine itself, and help heal both in the short- and long-term. They are effective in treating mild-to-moderate episodes of IBD. They also are useful in preventing relapses (return of symptoms).
- Corticosteroids:These medications, which include prednisone, prednisolone, and budesonide, affect the body’s ability to begin and maintain an inflammatory process. In addition, they work to keep the immune system in check. Prednisone and prednisolone are used for people with moderate-to-severe Crohn’s disease and ulcerative colitis. Budesonide is used for people with mild to moderate Crohn’s disease and ulcerative colitis . They can be administered orally, rectally, or intravenously. Effective for short-term control of acute episodes (flares), they are not recommended for long-term or maintenance use because of their side effects. If you cannot discontinue steroids without suffering a relapse of symptoms, your doctor may add some other medications to help manage your disease. It is important not to suddenly stop taking this medication.
- Immunomodulators:These include azathioprine, 6-mercaptopurine (6-MP), methotrexate, and cyclosporine. This class of medications modifies the body’s immune system so that it cannot cause ongoing inflammation. Usually given orally (methotrexate is injectable), immunomodulators are typically used in people for whom aminosalicylates and corticosteroids haven’t been effective, or have been only partially effective. They may be useful in reducing or eliminating reliance on corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take up to three months to begin working.
- Biologic therapies:These therapies are genetically engineered to target very specific molecules involved in the inflammatory process. The newest class of therapy to be used in IBD, these include adalimumab, certolizumab pegol, golimumab, infliximab, natalizumab and vedolizumab. These are not drugs, but proteins (antibodies) that target the action of certain other proteins that cause inflammation. These medications are indicated for people with moderately to severely active disease who haven’t responded well to conventional therapy. They also are effective for reducing fistulas. (Fistulas, which may occur with Crohn’s disease, are small tunnels connecting one loop of intestine to another or two organs in the body that are usually not connected.) Biologics may be an effective strategy for reducing steroid use, as well as for maintaining remission.
- Antibiotics:Metronidazole, ciprofloxacin, and other antibiotics may be used when infections— such as an abscess—occur. They treat Crohn’s, colitis and perianal Crohn’s disease. They are also used for post-surgical problems such as pouchitis.
Sometimes doctors will prescribe medications that the Food & Drug Administration (FDA) has not specifically approved for the treatment of Crohn’s or colitis. Nonetheless, these medications have been shown to be very effective in reducing symptoms. Prescribing medications for other than FDA-approved conditions is known as “off- label” use. Your healthcare provider may have to obtain prior approval from insurance companies before prescribing a medication for off-label use. Patients should be aware that they or their doctor might need to make a special appeal to get third-party insurance payment for off-label medication.
The use of substances found in nature, such as herbs, foods, and vitamins, is considered biologically-based practice. Unlike pharmaceutical products, natural remedies are not regulated by the FDA.
Making the most of your treatment
Crohn’s disease and ulcerative colitis are long-term diseases. This means that people with these conditions may need to take medication indefinitely. While not every person with IBD will be on medication all of the time, most people will require therapy most of the time.
For many individuals—particularly children and teenagers—this may seem like a major concern, especially when some of those medications produce unwanted side effects. If you are experiencing unpleasant side effects or interactions with other drugs, don’t stop taking your prescribed medication. Speak with your doctor and ask about possible adjustments that might reduce those effects.
Even when there are no side effects, or just minimal ones, it may still seem like a nuisance to be on a steady regimen of medication. Seek support from your healthcare provider. Remember, though, that taking maintenance medication can significantly reduce the risk of flares in both Crohn’s disease and ulcerative colitis. In between flares, most people feel quite well and free of symptoms.
Tips to Help You Manage Your Medications:
- Taking medication correctly means more than just taking the right amount at the right time. Talk to your doctor or pharmacist and learn as much as possible about the medications you take and how they may affect you.
- Take medications as directed. Remember, more is not necessarily better.
- Some medications require close monitoring for side effects. Don’t forget to complete blood work and follow-up visits as requested by your provider.
- Read drug labels carefully. If the print on the container is difficult to read, ask your pharmacist if it can be made larger.
- Use the same pharmacy every time you get your prescription filled. Pharmacies can help you keep track of what you are taking.
- Don’t take any medications that have expired.
- Don’t take anyone else’s medications or share yours with others.
- Tell your doctor or pharmacist about all medicines you take, including OTC, vitamins, and herbs.
- Don’t forget to take your medications with you when you travel or will be away from home. Before you leave, make sure you have plenty in case of delays.
Above all, do not stop taking your medications without your doctor’s approval even if you feel you cannot afford them. It is important that you take medications as prescribed, as some cannot be safely stopped abruptly. If the cost of treatment presents a problem for you, that is still not a reason to cut back or discontinue it. A number of patient assistance programs can help. Contact the Crohn’s & Colitis Foundation of America (www.ccfa.org) for more information.
What to Ask Your Healthcare Provider About Your Medications
It is only natural that you will have some concerns about the treatment that you (or your child) will be receiving for IBD. What should you ask your doctor? What do you need to know about your treatment or your child’s treatment? Following are some of the questions you may want to ask:
- Why is this medication necessary?
- How long will I need to take this medication?
- How does this medication work?
- Can I take vitamins, minerals, herbs, or other supplements while using the medication?
- Can I take over-the-counter (OTC) medications for joint pain, diarrhea, or abdominal pain?
- What kind of side effects might I experience? Which are cause for alarm, and what should I do if these occur?
- Which OTC products would you recommend for me to take if I have pain or other symptoms?
- What kind of interactions does this IBD medication have with other medications I may be taking for other conditions?
- What should I do if I miss a dose?
- What should I do if I have a negative reaction immediately after taking my medication?
- Is it safe to drink alcoholic beverages while on this medication?
- What should I do if I can’t afford my medication?
Remember to Tell the Doctor
Before starting new medications, it is important for you to tell your doctor and other healthcare providers (including dentists or emergency room staff) about other medications you may be taking. Tell them whether you:
- Have taken this drug before (even if there was no unusual reaction).
- Have had an unusual or allergic reaction to this drug, or other medications.
- Have or have had any other medical conditions.
- Take any other medication or drugs (prescription or over-the-counter).
- Take any vitamins, minerals, herbs, or other supplements.
Improving quality of life
CCFA has established a range of educational brochures, fact sheets, and programs designed to increase awareness about these digestive diseases.
We know living with Crohn’s or colitis can be difficult,but the right resources and support can make day-to-day living more comfortable. That’s why CCFA has developed a comprehensive, free online community (www.ccfacommunity.org) to provide the support individuals need in managing their condition. Support groups are also available in many locations. Find groups in your area at: www.ccfa.org/chapters, or call 1-888-694-8872.
For further information, call CCFA at our Information Resource Center: 888.MY.GUT.PAIN (888.694.8872).
The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.
About this resource
Published: November 30, 2009