Inflammatory Bowel Disease

Both UC and CD are chronic conditions. This means that although the symptoms of the disease may come and go, the patient still has the condition for life. Patients will have flare-ups and will need to be on medications to prevent them. A patient with ulcerative colitis (UC) may undergo surgery to remove the problem but may still have some chronic symptoms.

Some patients can link increased stress to a flare-up. For these patients, they can decrease their stress level by practicing relaxation techniques and breathing exercises and by taking better care of themselves. They can also avoid foods that they know irritate their stomach. This can help decrease some of the symptoms associated with IBD.

Other patients require medications. Patients should not take over-the-counter products unless they talk with their doctor first. A class of medications known as non-steroidal inflammatory drugs or NSAIDs (such as Motrin, Aleve, Advil) can make the disease worse. Although they are anti-inflammatories, they can irritate the digestive tract which can lead to ulcers and further flare-ups.

In general, the same medications (listed below) are used to prevent and treat flare-ups, with the exception of corticosteroids. The goals of IBD treatment are to:

  • Treat the condition and prevent associated symptoms from coming back.
  • Provide the patient with an improved quality of life.
  • Reduce the need for long-term corticosteroids.
  • Minimize the need for surgery.
  • Lower the risk of developing cancer.

The following medications are most commonly used to treat IBD, particularly UC and Crohn’s disease (CD):

Aminosalicylates (5-ASAs)

are anti-inflammatories that may be used to prevent UC flare-ups or keep UC in remission. They may be taken two ways:

By mouth
Sulfasalazine, mesalamine, olsalazine and balsalazide. Patients taking sulfasalazine should also take folic acid as well as be checked for low red blood cell count.

By rectum
mesalamine enemas and suppositories. These medications tend to be more effective than steroids.

Corticosteroids (steroids)

help prevent swelling and lessen pain. They are often used when 5-ASAs do not work. When taking these medicines, it is important to remember that:

The way you take the medicine depends on what part of the intestines IBD is affecting as well as the severity of the condition. Corticosteroids may be taken:

Through an IV
Methylprednisolone, hydrocortisone

By mouth
Prednisone, prednisolone, budesonide, dexamethasone

By rectum
Enema preparations, suppository

Because side effects can be severe, these medicines are used for short periods of time.

If you need surgery, you must slowly come off these medicines first. That way, you can avoid complications during your operation.

Antibiotics

treat and prevent infections in the intestines. Common side effects include diarrhea, nausea, and vomiting. Antibiotics may be taken:

By mouth
Metronidazole and ciprofloxacin

Immune modifiers

suppress the immune system to lower inflammation caused by CD. They are often used if treatments with 5-ASAs and corticosteroids have not been effective. Common side effects are nausea, vomiting, diarrhea, increased risk of infection, decreased white blood cell counts, and liver damage; however, side effects can be serious and vary depending on the medication.

These medications may be taken:

By mouth
Thiopurines: 6-mercaptopurine and azathioprine; and calcineurin inhibitors: cyclosporine and tacrolimus

By mouth or injection
Methotrexate

If you are taking one of these medications, you need to have your complete blood count checked monthly to make sure your immune system is not suppressed too much.

Biologics

are drugs made from living organisms that target specific proteins in the inflammatory process. For example, certain biologics block a substance called TNF-alpha from binding to their body and leading to swelling. They are used to treat moderate to severe CD when people don’t respond well to other medications.

Common side effects include stomach pain, weakness, decreased white blood cells and platelets, and an increased risk of infections. Call your doctor immediately if you have an infection or fever. Common symptoms of infection include fever, difficulty breathing, or vision changes.

Biologic may be taken:

Through a self-administered injection
Humira, Cimzia, Simponi, Stelara

Through an IV
Remicade, Tysabri, Entyvio


Treating IBD symptoms

Your doctor will prescribe you medications to treat IBD, but you may have other symptoms that may need to be addressed. Please talk to your doctor if you develop any of the following symptoms. You may need to take other medications or supplements to help you improve your quality of life. You should not use supplemental medications without first speaking to your pharmacist or doctor.

Weakness
Provigil, amantadine, low dose naltrexone

Depression
Anti-depressants, anti-anxiety medications with behavioral counseling

Rectal pain
Acetaminophen

Malnutrition
Nutritional supplement

Diarrhea
Imodium or cholestyramine

Vitamin deficiency
Vitamin B-12, vitamin D, calcium, multivitamin, iron


Overcoming Medication Challenges

It is important for you to know the benefits of your medications. Here at Magellan Rx, we understand your concerns and want to help you with any difficulties you may encounter. For additional information on how to overcome medication challenges, please click here: Overcoming Medication Challenges