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Those funny chemicals:
Medications prescribed to treat IBD

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With any new treatment, whether traditional or alternative, it's a good idea to make some kind of plan.

Ask yourself: what are your goals with the treatment, how long do you plan to try it and does the treatment -- after some set time -- fulfill your goals positively? This way, especially with long-term maintenance therapies, you can make sure you are getting the most out of the time, energy and money you invest.

On a side note, your doctor recognizes that you, the patient, are ultimately in charge of your own care, so don't be afraid to tell your physician if you decide to stop a medication (although it's best to get your doctor's approval first) or if you're interested in changing your therapy.

Because medications are so important, you'll want to track what you're on (not "the brown one"), the dosage and effects. Use the medications record and stoplight plan to help organize when to take which medication.

Common medications used to treat IBD

Take notice: The side effects listed below may not occur at all and, conversely, some of them may look like IBD symptoms. If those particular effects worsen, call your doctor to figure out whether they result from the medication or a flare-up.

The following is a list of the more commonly prescribed medications for IBD and their associated side effects.

Aminosalicylates

Aminosalicylates are the most common group of drugs prescribed to treat IBD. These include sulfasalazine (Azulfidine) and mesalamine (Asacol, Pentasa, Rowasa enemas and Canasa suppositories), Olsalazine (Dipentum) and Balsalazide (Colazal). Aminosalicylates generally are used for treatment of mild to moderate ulcerative colitis or Crohn’s.

WARNING: If you’re allergic to aspirin, you’ll have the same allergy to aminosalicylates.

Sulfasalazine may cause:

• Headaches
• Dizziness
• Nausea
• Vomiting
• Diarrhea
• Loss of appetite
• Pancreatitis (inflammation of the pancreas)
• Skin sensitivity to sunlight
• Orange-yellow discoloration of urine and skin
• Anemia
• Allergic reactions -- if you develop an allergic reaction, like a skin rash, immediately stop taking the drug and call your doctor.

Mesalamine, which is essentially sulfasalazine without sulfa, has less-frequent side effects that include:

• Headaches
• Malaise (a general feeling of weakness or discomfort)
• Abdominal pain
• Cramping
• Diarrhea
• Flatulence (that’s gas)
• Yellow-brown discoloration of urine
• Pancreatitis
• Alopecia (a very uncommon patchy loss of hair)

Corticosteroids                 return to top

Corticosteroids (mainly Prednisone) make up the second most common group of drugs used to treat IBD. Corticosteroids are fast-acting, shorter-term drugs generally used for acute flare-ups of  Crohn’s and colitis. While aminosalicylates only control inflammation, corticosteroids are anti-inflammatory and also immunosuppressive (they reduce the activity of your immune system).

With short-term use, the most common side effects of Prednisone are:

• Increased appetite
• Weight gain
• Facial swelling (lessened by reducing salt intake)
• Acne
• Heartburn
• Hair growth

• Significant mood swings (anger, depression, elation)

With long-term use, side effects are:

• Stretch marks
• Delayed growth
• Diabetes
• Osteoporosis (a loss of bone density)
• Hypertension (high blood pressure)

Budesonide is another corticosteroid used in treatment of Crohn’s involving the ileum and cecum and has similar but less-intense side effects than Prednisone.

Antibiotics                return to top

Antibiotics (mostly Flagyl and Cipro) are a group of medications that help maintain a balance between the millions of bacteria, both good and bad, that your intestine hosts. Medtronidazole (Flagyl) and ciprofloxacin (Cipro) are the most commonly prescribed antibiotics and generally are used to treat active Crohn’s and to stop active fistulas.

Metronidazole also is used in colitis and Crohn’s to suppress an inflammation-causing overgrowth of the bacterium C. difficile. Its side effects include:

• Nausea
• Vomiting
• Loss of appetite
• Diarrhea
• Dizziness
• Headaches
• Tingling of hands and feet with long-term use (possibly irreversible if drug use is continued)

• Discoloration of urine to a dark or reddish brown

WARNING: Flagyl affects the breakdown of alcohol, giving you lots of nasty symptoms. Avoid alcohol in any form while on Flagyl and until at least two days after the last dose.

Ciprofloxacin side effects include:

• Headaches
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Rash

• Restlessness

Note: Cipro can interact with antacids (such as Tums) so try not to take both within the same few hours.

Immunomodulators            return to top

Immunomodulators include 6-mercaptopurine (6-MP and Purinethol) and azathioprine (Imuran) and are used for long-term maintenance. Immunomodulators also affect your immune system.

Mercaptopurine and azathioprine have similar side effects including:

• Nausea

  Get regular blood tests (ask your doctor how often) when on 6-MP, Imuran, methotrexate, cyclosporine or tacrolimus.

• Low white-blood-cell count
• Increased risk of infection
• Pancreatitis
• Liver damage
• Headache
• Rash

• Fever

Note: Sometimes changing from mercaptopurine to azathioprine or vice versa can reduce any nausea or headaches that you may experience.
 

Methotrexate (Mexate) may be used with Crohn’s when mercaptopurine or azathioprine isn’t tolerated or effective. Methotrexate is given by injection once a week and sometimes by mouth after it has started to work. It also affects the immune system.

Methotrexate's side effects include:

• Low white blood cell count
• Liver damage
• Nausea
• Vomiting
• Headache
• Fatigue

• Diarrhea

WARNING: Methotrexate is known to cause fetal death and congenital abnormalities and must be avoided during pregnancy and breastfeeding and by both men and women planning conception. Couples should avoid pregnancy until at least three months after a male stops the drug or until the completion of one full ovulation cycle after a female stops the drug. If you’re a female and get pregnant while on methotrexate, talk to your doctor immediately.
 

Cyclosporine and tacrolimus             return to top

Cyclosporine (Neoral, Sandimmune, SangCya) and tacrolimus (Prograf) are other immune-suppressive drugs used infrequently for very acute ulcerative colitis unresponsive to steroids. Both have similar side effects:

• Decreased kidney function
• Hepatitis (inflammation of the liver)
• Increased risk of infections
• Diabetes
• Increased cholesterol levels
• Sleep problems
• Headache
• Mild tremor
• Tingling of the fingers and feet
• High blood pressure
• Increased hair growth (with Cyclosporine only)

• Increased risk of lymphomas

Notes:

• Blood pressure and kidney function need to be checked regularly.
• Avoid grapefruit juice when on these drugs because it can increase the amount of cyclosporine or tacrolimus in your bloodstream.
• Antacids (like Tums®) interact with tacrolimus, so take the antacids and tacrolimus at least two hours apart.

Infliximab                return to top

Infliximab (Remicade) is an antibody that decreases inflammation. Infliximab is expensive but very effective for patients who have not responded to other treatments. To prevent allergic reactions, anyone on Infliximab should be on an immunomodulating drug (mercaptopurine, azathioprine, methotrexate) at the same time. Infliximab is administered by IV and usually is given every eight weeks. Each infusion takes about two hours. Because infliximab is given intravenously, it can have a set of infusion reactions including fever, chills and rashes.

The most common side effects from the medicine are:

• Difficulty breathing
• Low blood pressure
• Rash
• Headache
• Nausea

• Upper respiratory infection (cough and sore throat)

Note: You always should have a TB (tuberculosis) skin test before you use Infliximab as it can increase the risk of active TB if you’ve had previous exposure.

Questions or comments

If you have questions or comments about this Web site, please e-mail LifeWithIBD@texaschildrenshospital.org.

It is not the intention of this Web site to provide specific professional medical advice, but rather to provide users with information about inflammatory bowel disease (IBD). If you are experiencing any symptoms associated with IBD, please contact a licensed medical doctor to diagnose, treat and professionally address those symptoms.

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