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Crohn's Disease Medications

The goal of drug therapy with Crohn’s disease is to reduce the inflammation of the intestines.  In as many as 80% of patients, drugs are effective in decreasing inflammation and associated symptoms.

The following are the most common medications prescribed to treat Crohn’s disease.

Corticosteroids

Steroids are employed to reduce inflammation and can be used to induce remission. 

Prednisone, prednisolone, hydrocortisone, and methylprednisolone are the most common corticosteroids.  These drugs are administered orally, intravenously, by injection, by enema, or by suppository.

Patients taking steroids for an extended period of time may need to take calcium and vitamin D supplements to prevent osteoporosis.

With an ample list of potential side effects your physician will begin reducing the amount of corticosteroids after the inflammation has subsided.  The reduction in dosage will be done gradually allowing the body to recover and regulate its own levels of natural steroids.  If the dose is lowered too fast withdrawal symptoms may occur, including fever, and joint pain. 

Prednisone Side Effects to Hate:

• increased rate of infection
• weight gain
• acne
• hypertension
• accelerated osteoporosis
• diabetes (type 2)
• cataracts or glaucoma
• menstruation irregularities
• a whole slew of emotional disorders: irritability, insomnia, psychosis, and depression

Budesonide (Entocort EC) is a relatively new corticosteroid used to treat IBD.  It targets the intestinal tract and causes fewer side effects than other corticosteroids like prednisone.

Mesalamine (5-Aminosalicylic Acid): Sulfasalazine

The compound 5-Aminosalicylic Acid (5-ASA) is commonly referred to as mesalamine, it shares a similar chemical structure to aspirin.  Mesalamine can be effective for IBD because of its inhibiting factors of the immune system that causes inflammation.

Sulfasalazine is the standard mesalamine formulation.  Sulfapyridine, a sulfa component, is added to prevent the mesalamine from being absorbed until it reaches the target inflammation in the colon.

There are other timed release varieties of mesalamine that allows the medication to target specific regions of the intestines. 

Pentasa is coated with ethyl cellulose which allows the drug to be slowly released from the stomach through the instestines.  Pentasa has been effective in patients when the disease occurs in the small intestines.

Asacol is coated with an acrylic which delays the release of the mesalamine until it reaches the last section of the ileum and the colon.

Prescribed for those with mild to moderate Crohn’s disease, mesalamine is often used in conjunction with steroids.

Mesalamine Side Effects to Hate:

• diarrhea
• nausea
• cramping

Immunosuppressive Drugs (immunomodulator)

Immunosuppressive drugs are used as long term therapies for Crohn’s disease when the patient does not respond to standard treatments.  By suppressing the actions of the immune system and its inflammatory response, immunosuppressive drugs assist in maintaining remission and healing of fistulas and ulcers.

The most common examples of immunosuppressive drugs are azathioprine (AZA), Imuran, 6-mercaptopurine (6-MP) (Purinethol), and methotrexate.

It may take 10 to 12 weeks for the drug to begin improving symptoms.  Patients taking immunosuppressive drugs need to be monitored by regular blood tests to check for effects on bone marrow, the liver and the kidneys.  Because these drugs weaken the immune system there is an increased risk of infection.

Side Effects to Hate:

• nausea, vomiting and diarrhea
• rash
• malaise
• liver inflammation

Antibiotics

Metronidazole (Flagyl), a commonly used antibiotic to treat Crohn’s disease, is sometimes successful in aiding the healing of fistulas and abscesses.  The drug works by destroying bacteria which helps control infections and reduce inflammation.

Metronidazole (Flagyl) Side Effects to Hate:

• tingling or numbness of the hands or feet
• nausea
• metallic taste in the mouth
• headaches
• dizziness
• loss of appetite

Ciprofloxacin (Cipro) in some patients can improve the symptoms of Crohn’s disease.  It is currently the favored antibiotic over metronidazole.

Ciprofloxacin (Cipro) Side Effects to Hate:

• fainting
• irregular heartbeat
• abdominal pain
• diarrhea, nausea, or vomiting
• fatigue

Tumor Necrosis Factors (TNF) Modifiers

Infliximab (Remicade) is an antibody or biologic response modifier that interferes with the body’s inflammatory response.  These drugs target the inflammatory immune factor of a molecule called tumor necrosis factor or TNF.

The first genetically engineered drug approved for Crohn’s disease, infliximab blocks the activity of tumor necrosis factor-alpha (TNF-a).  It is used when the disease is not responding to other medications.  Infliximab has been successful in inducing remission in up to 80% of patients after one infusion.  Approximately half of patients with perianal disease experienced closing or healing of fistulas.

Infliximab is administered intravenously by your GI or other licensed health care professional.  This drug decreases the effectiveness of the body’s immune system which exposes the patient to an increase risk of bacterial infection. 

There may be an increase risk of lymphoma or cancer of the lymph glands.  Studies are currently being conducted to determine the link between taking infliximab and lymphoma.

In 2007 the US FDA (Food and Drug Administration) approved another TNF blocking drug called adalimumab (Humira).   Similar to infliximab, adalimumab is administered by injection and is used to treat moderate to severe Crohn’s disease.

Infliximab (Remicade) Side Effects to Hate:

• nausea, fever, dizziness, chills
• headaches
• rash
• hives
• low blood pressure
• labored breathing
• pruritus (sensation of itching)

Anti-Diarrheal

People experiencing mild symptoms of Crohn’s disease may respond to anti-diarrheal medications such  loperamide (Imodium A-D), available over the counter and by perscription.  These products can sometimes cause painful spasms as well as reduce the number of bowel movements.  Anti-diarrheal medications such as loperamide should be taken with plenty of fluids.

Loperamide (Imodium) Side Effects to Hate:

• nausea, vomiting, dizziness
• abdominal pain
• constipation

Other anti-diarrheal medications include codeine, diphenoxylate and atropine.  Long term use of these drugs is sometimes discouraged as they can be habit forming.  They control chronic diarrhea and act as a mild sedative to provide pain relief.

Nutrition Supplements

Doctors sometimes recommend the use of nutritional supplements.  High-calorie liquid formulas can be used in children experiencing low growth rates. 

A small number of patients need to receive their nutrients intravenously (TPN or total parenteral nutrition) through a small tube.  This procedure gives the patient extra nutrition when the intestines are having difficulties absorbing enough nutrition from food.  TPN is also used after surgery to give the intestines a break to accelerate recovery.