Medication Options
The table below outlines all of the current common medication options for the treatment of IBD in adulthood. Similar medications to treat IBD are used in adult care and pediatric care, however there are some exceptions.
SUMMARY TABLE
| Medication | Purpose/Action | Example | Notes |
|---|---|---|---|
| Antibiotics | Antibiotics are used in the treatment of IBD for infections that can occur with fistulas, abscesses, pouchitis, infections of the intestine. | Ciprofloxacin, Metronidazole/Flagyl®, Amoxicillin/Clavulanate (Clavulin), Vancomycin |
| Medication | Purpose/Action | Example | Notes |
|---|---|---|---|
| 5-Aminosalicylates (5-ASA; mesalamine) | 5-ASA medications are used primarily to treat mild-moderately severe ulcerative colitis (UC). They work topically to reduce inflammation in the lining of the intestine. | Asacol®, Mesasal, Mezavant®, Pentasa®, Salofalk®, Sulfasalazine/Salzapyrine® | These medications are given both orally (by mouth) and/or rectally (either suppositories or enemas). |
| Medication | Purpose/Action | Example | Notes |
|---|---|---|---|
| Corticosteroids | Corticosteroids are powerful anti-inflammatory medications that are used to induce remission for IBD. They suppress the overall immune system through many mechanisms. | Prednisone, Budesonide/Entocort®, Methylprednisone/ Solumedrol ®, Hydrocortisone/ Cortenema®, Cortifoam® |
Corticosteroids have many side effects – both short-term and long-term, therefore corticosteroid use should be limited. Since the adrenal glands in your body also make corticosteroids, it is important not to abruptly stop these medications. |
| Medication | Purpose/Action | Example | Notes |
|---|---|---|---|
| Immunosuppressants | Immunosuppressants are used to suppress your immune system – to stop it from attacking your gastrointestinal tract.
Typically these medications are used to maintain remission alone or in combination with biologic medications. |
Azathioprine/ Imuran®, Mercaptopurine/ Purinthol®, Methotrexate |
| Medication | Purpose/Action | Example | Notes |
|---|---|---|---|
| Biologics | Biologics are a class of medications that are extracted or made from biologic sources. The biologics that are used in IBD are monoclonal antibodies that are designed to target different aspects of the inflammatory pathway.
The generic names of monoclonal antibodies end in “–mab”. The types of monoclonal antibodies used in IBD can be categorized by the target. |
Infliximab/Remicade®, Adalimumab/Humira®, Golimumab/Simponi®, Vedolizumab/ Entyvio®, Natalizumab/Tysabri®, Ustekinumab/Stelara® | The medications are expensive; therefore there are patient support programs (PSP) to help you coordinate insurance costs and arrange for infusions or injections. |
Medications used in Pediatrics ONLY:
One form of treatment that can be used in pediatrics but not in adult care is enteral nutrition. Exclusive enteral nutrition is used in pediatrics to induce remission with newly diagnosed Crohn’s disease. Enteral nutrition is an entirely liquid diet (eg: Nutren® or Ensure ®) that is given either through a small nasogastric (NG) tube directly into the stomach or small intestine. This treatment is hard to sustain for a long period of time as no other food can be consumed during this therapy, so is usually prescribed for only 6-8 weeks. It is used in place of prednisone to induce remission.
Medications used in Adults ONLY:
New medications approved for the treatment of IBD are usually available for adult patients before they are approved for children. This is because in order for medications to be approved for use by Health Canada, there need to be clinical trials showing that they are beneficial – adult studies are usually done before pediatric studies.
To TopMedication Safety
Whenever you begin a new medication, make sure that you have reviewed its use and potential side effects with the doctor or nurse as well as the pharmacist dispensing it. It is important to equip yourself with the knowledge of why you are taking something as well as how it works and might affect you. It is also critical that your gastroenterologist, family physician and pharmacist know all of the medications (including herbal remedies or supplements) you are taking, so be sure to update this information with them at each appointment if there are any changes.
If you experience a side effect or worsening of symptoms, it is recommended that you speak with your family physician, IBD nurse, or gastroenterologist. If you have a fever while on corticosteroids, immunosuppressant and/or biologics, seek medical attention as this may be a sign of infection.
Safety of herbal remedies – You must let your physician know if you are taking any supplements or alternative medicines, as some of them may interact with your prescribed medications. Just because something is natural or herbal, this does not mean that it is necessarily safe.
If your medication makes you more sensitive to sun exposure (Ciprofloxacin, Sulfasalazine, Imuran, Methotrexate) wear sunscreen and talk to your physician about sun protective behaviours. Also note that you should not be drinking alcohol on certain medications listed above (Methotrexate, Metronidazole).
Everyone’s disease is a little bit different and that is why there are a variety of medication options. Some will work better or worse for other people. Whatever medication you are on, it is important to follow the prescribed schedule and dosage. If there are serious health risks with your medication, your gastroenterologist will have you complete regular bloodwork and it will be monitored for any blood count changes.
If you are pregnant or considering becoming pregnant, discuss medication options with your gastroenterologist. You must not take methotrexate if you are pregnant or planning to get pregnant. See the section about pregnancy.
To TopMedication Adherence
Taking your medications as prescribed helps you stay in remission and avoid flares. If you feel well, that doesn’t mean you should stop your medications. IBD medications are not a “cure,” they are a long-term treatment that protects your GI tract from attack by your immune system. If you take away the medications, it would be like turning off the water hose fighting a house fire or throwing away a shield in a sword fight – meaning that inflammation would increase, potentially causing damage (sometimes irreversible) to your intestines and you could experience a flare.
Unfortunately, even if you always take your medications it doesn’t mean that you will always feel well and not have flares on your medications – but taking them does reduce this risk. It is a good idea to discuss your symptoms and any changes with your gastroenterologist so you can feel confident about taking your current medication or investigate other options together. Cutting back or increasing medications yourself is not a good idea. As adults, you need to make informed choices – you are the expert on your body, and you need to be the expert on your medications, too.
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