Medications used to treat IBD
Medication can reduce inflammation and ease (or eliminate) symptoms of IBD, but treatment for IBD is an inexact science, given that the cause of IBD is not known. One person’s apparently-successful treatment program won’t necessarily have the same results on others. When considering options, the potential benefits must be weighed against the potential risks. There is no miracle treatment for IBD, but there are proven medications, nutritional therapies and surgery. Different combinations of these treatments will be right at different stages of the disease and help to reduce inflammation ,symptoms , treat complications and help maintain remission.
Sulfasalazine
Used to treat mild-to-moderate attacks of IBD. It reduces inflammation and diarrhoea. In ulcerative colitis it markedly reduces the likelihood of flare-ups (recurrence). Taken regularly it continues to have this effect indefinitely. Although it benefits some patients with Crohn’s disease, not to the extent it does in ulcerative colitis. It has been used for more than 50 years to treat IBD and can help arthritis which is seen in 20% of IBD patients.. It is a sulfa drug that has two components: sulfa, which is a “carrier” for the active ingredient; and the active ingredient itself, 5-aminosalicylate (5-ASA).
As the intestines of people with IBD produce more diarrhea-causing chemicals it reduces the production of those chemicals in order to decrease inflammation and allow healing. It also acts to remove oxygen radicals which are released during inflammation and can damage tissues and kill cells.
It may be prescribed indefinitely – this is called maintenance therapy – because it significantly reduces the chances of flare-ups. Flare-ups will still happen, but not as often.
Common side effects are gastro-intestinal: nausea and reduced appetite; sometimes vomiting. The second-most-common side effect is an allergic reaction to the sulfa Symptoms include hives (itchy rash), swollen hands and/or face. This reaction usually happens within three weeks of starting the medication. The drug’s use should be discontinued if there is an allergic reaction.
A much-less-common side effect is hemolysis (shortening of the lifespan of the red blood cells, which normally regenerate every four months). A very serious, but highly unlikely, side-effect is bone-marrow shutdown (“marrow aplasia”). Bone marrow produces the essential red and white blood cells and platelets. If there is unusual bleeding or bruising, the doctor should be seen at once.
Sulfasalazine can also reduce the ability of the intestine to absorb folic acid (or folate, one of the B vitamins). . People taking sulfasalazine may need to take a vitamin supplement to avoid this problem.
Other possible side effects: Headaches; yellowing of contact lenses; orange-coloured urine; reduced sperm count (which reverses back to normal once the drug is stopped).
5-Aminosalicylate (5-ASA)
Also known as: Mesalamine, mesalazine, olsalazine.
Similar to sulfasalazine, 5-ASA is used to treat mild-to-moderate flare-ups of IBD. It decreases inflammation and reduces diarrhoea and may also prevent flare-ups of IBD in some people. Those with proctitis (colitis limited to the rectum) or colitis involving the last metre of the colon may find that 5-ASA is more effective taken rectally, rather than orally. It may also delay the return of Crohn’s disease after surgery.
5-ASA is now often used instead of sulfasalazine, if neither one has been given before. It is the alternative treatment for people who can’t take sulfasalazine because they can’t tolerate its sulfa component.
Like sulfasalazine, 5-ASA reduces the production of diarrhea-causing chemicals in the intestine. Also like sulfasalazine, it inactivates oxygen radicals that can destroy tissue.
Possible side effects: They are the same as for sulfasalazine, but they occur far less commonly: At the start of treatment, patients may experience nausea, headaches, diarrhoea. Less common side effects include allergic reactions and abdominal pain.
Glucocorticosteroids (Steroids)
Also known as: Prednisone, hydrocortisone, betamethasone, tixocortol, budesonide.
Used to treat moderate and severe attacks of IBD. Steroids reduce inflammation, and do so more powerfully and more effectively than the 5-ASA drugs. but have bad long term side effects so should not be used for longer than 2-3 mths at a time.
Steroids are derived from cortisol, a natural steroid produced by the adrenal glands. These are not the same as anabolic steroids (used by athletes) or sex hormones.
Possible side effects: Rounding and/or redness of the face, hair growth on the face, acne. In children, reduced growth rate or delayed puberty. Ankles may swell because of increased fluid . In long-term users, fat may develop in the arms and legs, and sometimes a fatty deposit forms in the middle/upper back. Muscle weakness in the thighs and upper arms can occur. Patients on steroids usually develop increased appetite and weight gain; increased energy and less need for sleep. Night sweats are also possible.
“Invisible” effects: Softening of bones , in patients who take large doses for long periods of time. Thinning of the skin in arms and legs, bruising happens more easily. Increased blood sugar can aggravate diabetes. Reduced potassium levels, increased eye pressure, cataracts. Occasionally peptic ulcers may occur.
Psychological effects: Steroids can change people’s moods: they may feel more energetic, have more appetite, and put on weight. They may also become depressed. Some people may feel nervous or “jittery”.
Rules for steroid use: When people take corticosteroids, their adrenal glands slow down, or completely stop, producing normal cortisol. When people stop taking corticosteroids ÷ and most prescriptions are only temporary, not for continuous use ÷ it takes some time for the adrenal glands to “kick in” again and resume producing cortisol. In the meantime, if that person should become ill or suffer stress, he or she may need to give the body a “boost” by supplementing natural cortisol with extra steroids. Some of the indications that a person is not producing enough cortisol naturally are: nausea, fatigue, weakness, light-headedness, and perhaps diarrhoea. The person’s doctor should be informed of a possible cortisol deficiency.
Steroid users should:
Never stop steroids suddenly.
Always remind, or inform new doctors that they take steroids.
Remind their doctor when they become ill that they’re using steroids.
Wear a medical alert bracelet that indicates steroid use.
Immunosuppressives
Also known as: Azathioprine, 6-mercaptopurine (6-MP), methotrexate,cyclosporine A.
Immunosuppressives suppress the immune system and reduce inflammation. . In some people they heal fistulas and often prescribed so that people can decrease or stop taking, steroids.
Possible side effects: as they reduce the effectiveness of the immune system. they lower the body’s overall ability to fight infection. People are more susceptible to infections. They should report any fevers, chills, or persistent sore throat to their doctor, and have blood tests done frequently.
Azathioprine and 6-mercaptopurine:
Azathioprine and 6-mercaptopurine (6-MP) are chemically very similar. In Crohn’s disease, it can take up to six months, or more, to see results from azathioprine and 6-mercaptopurine. In ulcerative colitis, improvements should take place within three months. Both azathioprine and mercaptopurine can help prevent flare-ups of both Crohn’s disease and ulcerative colitis.
Side effects from azathioprine and 6-MP include reduced appetite and nausea, sometimes vomiting, and canker sores in the mouth. A serious (and life threatening) side effect is reduced activity of bone marrow, but this can be monitored with regular blood tests. As well, users should watch for unusual bleeding and/or bruising. A few people may develop pancreatitis (inflammation of the pancreas) some months after starting these drugs.
Methotrexate: This drug works within 4-6months for Crohn’s disease. Methotrexate has similar side effects to azathioprine and 6-MP, except instead of pancreatitis, the patient may develop scarring of the liver, and, in severe cases, cirrhosis of the liver.
Cyclosporine A: An attack of ulcerative colitis can improve within a few days when cyclosporine is taken by injection, but the medication can have severe side effects. The most serious one (but much less frequent, because of the small doses involved) is temporary or permanent kidney damage. Other side effects include high blood pressure, increased facial hair, enlarged gums and liver damage.
Antibiotics
Also known as: “Broad-spectrum” antibiotics: metronidazole, ciprofloxacin, ampicillin, cefazolin, gentamicin, tobramycin.
When the colon is badly inflamed, bacteria may break through the intestinal wall into other tissues even into blood. In severe attacks this can result in complications such as infected blood (septicemia) and boils (abscesses) in the liver. In ulcerative colitis, antibiotics are always combined with other drugs. In Crohn’s disease, antibiotics can be used as primary therapy (the only medication given). Antibiotics may also clear up infections and sores around the anus.
Note: Some antibiotics suppress the growth of normal bacteria and allow the overgrowth of the Clostridia bacteria in the colon. In turn, this can produce a toxin which actually causes diarrhoea.
Specific Medications
Metronidazole (the most-prescribed antibiotic for Crohn’s Disease)
Used mainly in Crohn’s disease to treat abscesses (boils) and fistulas (abnormal openings) in or near the anus. Used to treat Crohn’s colitis (Crohn’s disease that affects the colon).
Up to 20 per cent of people using metronidazole experience side effects. Common side effects include nausea and decreased appetite. Less common are vomiting, constipation, diarrhoea and indigestion. Taste sensations may be altered. When used long-term, feet may become numb, balance may become unsteady, but these effects usually diminish and disappear after medication stops. If someone experiences this numbness they should stop taking medication and consult their doctor immediately.
Other side effects , Dizziness, headache, drowsiness, confusion, difficulty sleeping, itchy rashes, vaginal discharge, darkened urine. Some patients can’t tolerate alcohol while using metronidazole.
Available as: Tablets, capsules, injectable form.
Ciprofloxacin (for Crohn’s disease)
Ciprofloxacin is effective in treating abscesses around the anus.
Possible side effects: About one per cent of users have nausea and diarrhoea. Ciprofloxacin prolongs (possibly increases) the stimulant effect of caffeine. The drug can also cause difficulty sleeping, and vivid dreams. May cause tendentious (inflammation of tendons).
Updated Aug 2003