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Medications for Inflammatory Bowel Disease

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medications are prescribed to help control inflammation and other symptoms.

Prescription Medications

Aminosalicylates (5-ASA)

  • Sulfasalazine
  • Mesalamine
  • Balsalazide
  • Olsalazine
  • Rectal administration forms (Rowasa enema, Canasa suppository)

Corticosteroids

  • Prednisone
  • Methylprednisolone
  • Budesonide
  • Rectal administration forms (enema, suppository, foam)

Immune Modifiers

  • Azathioprine
  • 6-mercaptopurine (6-MP)
  • Methotrexate
  • Cyclosporine
  • Tacrolimus

Antibiotics

  • Metronidazole
  • Ampicillin
  • Ciprofloxacin

Biologic Therapy

  • Anti-tumor necrosis factor agents:
    • Infliximab
    • Adalimumab
    • Certolizumab pegol
    • Golimumab
  • Integrin receptor antagonists:
    • Natalizumab
    • Vedolizumab

Antidiarrheals

  • Diphenoxylate-atropine
  • Loperamide
  • Codeine
Aminosalicylates

Common names include:

  • Sulfasalazine
  • Mesalamine
  • Balsalazide
  • Olsalazine
  • Rectal administration forms (Rowasa enema, Canasa suppository)

Aminosalicylate drugs help control inflammation in the colon. Precisely how they work is unknown. The active ingredient is released after bacteria in the bowel metabolize the drug.

Possible side effects include:

  • Nausea and vomiting
  • Heartburn
  • Diarrhea
  • Headache
  • Skin rash
Corticosteroids

Common names include:

  • Prednisone
  • Methylprednisolone
  • Budesonide
  • Rectal administration forms (enema, suppository, foam)

Corticosteroids reduce inflammation by suppressing the immune system. They are ordered for more severe episodes of inflammatory bowel disease. They may be taken by mouth, injected, or given by enema or suppository. Do not suddenly stop taking these medications. Follow your doctor’s instructions for tapering the dose.

Possible side effects include:

Immune Modifiers

Common names include:

  • Azathioprine
  • 6- mercaptopurine (6-MP)
  • Methotrexate
  • Cyclosporine
  • Tacrolimus

Immune modifiers block the immune response that helps produce inflammation. These drugs take a long time (months) to work and are usually started with another, more fast-acting drug.

Possible side effects include:

  • Bone marrow suppression
  • Increased risk of infection
  • Nausea and vomiting
  • Diarrhea
Antibiotics

Common names include:

  • Metronidazole
  • Ampicillin
  • Ciprofloxacin

Antibiotics are given to treat infections. In Crohn's disease and ulcerative colitis, the bowel wall is more susceptible to infection once the lining of the small or large intestine is damaged. Infections are caused when bacteria penetrate the bowel wall. Antibiotics may also be prescribed before bowel surgery. Take antibiotics with food to decrease stomach upset. It is very important that you finish the complete course of therapy. Do not stop taking the antibiotics even if you feel better. Do not drink alcohol while taking antibiotics.

Possible side effects include:

  • Upset stomach
  • Diarrhea
  • Vaginal yeast infections
  • Bacterial colitis
Biologic Therapy
  • Anti-tumor necrosis factor agents:
    • Infliximab
    • Adalimumab
    • Certolizumab pegol
    • Golimumab
  • Integrin receptor antagonists:
    • Natalizumab
    • Vedolizumab

These drugs have been approved to treat severe disease that does not respond to other treatments. TNF-inhibitors is a genetically engineered antibody that binds specifically to tumor necrosis factor (TNF) and blocks its activity in the body. Infliximab is infused into a vein at prescribed intervals. Adalimumab and certolizumab can be given at home.

Integrin receptor antagonists block the effects of leucocytes (white blood cells that cause inflammation). They inhibit a protein that coats the leucocytes and keep them from moving into the tissuessues..

Possible side effects include:

Antidiarrheals

Common names include:

  • Diphenoxylate-atropine
  • Loperamide
  • Codeine

These drugs are given to manage diarrhea during active episodes of the disease. They slow movement through the intestines. Although loperamide in liquid form is available without a prescription, the prescription-only capsule form is used for the treatment of inflammatory bowel disease.

Possible side effects include:

  • Drowsiness
  • Constipation

Special Considerations

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

Revision Information

  • Reviewer: Daus Mahnke, MD
  • Review Date: 09/2016 -
  • Update Date: 10/04/2016 -
  • Crohn disease in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114217/Crohn-disease-in-adults. Updated September 7, 2016. Accessed October 4, 2016.

  • IBD. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-care/conditions-diseases/ibd. Accessed October 4, 2016.

  • Types of medications. Crohn's & Colitis Foundation of America website. Available at: http://www.ccfa.org/resources/types-of-medications.html. Accessed October 4, 2016.

  • Ulcerative colits. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114507/Ulcerative-colitis. Updated September 28, 2016. Accessed October 4, 2016.

  • 12/3/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114507/Ulcerative-colitis: Zabana Y, Domènech E, Mañosa M, et al. Infliximab safety profile and long-term applicability in inflammatory bowel disease: 9-year experience in clinical practice. Aliment Pharmacol Ther. 2010;31(5):553-600.