Managing Crohn’s Disease: Medicines

Types of medicines

You may be prescribed one or more of these types of medicines:

• Corticosteroids

• Immunomodulators

• Biologic agents

• Antibiotics

• Aminosalicylates

• Small-molecule medicines

You can learn more about each kind below.

Corticosteroids

Your doctor may advise you to take corticosteroids. These help to calm inflammation in your body. This can make your symptoms better quickly. You may take corticosteroids as a pill or liquid by mouth. In some cases, they may be given through an intravenous (I.V.) line. Or they may be given rectally as either a suppository or an enema. You take them for a short time, usually not longer than 8 to 12 weeks. You do not take them when you are in remission. Remission is a long period with no symptoms.

If used for a long time, side effects may include:

• Mood changes.

• Trouble sleeping.

• Changes in body shape.

• A higher chance of developing infections.

• A puffy face or acne.

• Weight gain.

• Stretch marks.

• Eye problems.

• Bone loss or breaks.

• Facial hair in women.

• Acne.

• High blood pressure.

• High blood sugar.

• Risk for diabetes.

Immunomodulators

These kinds of medicines cause your body’s immune system to be less active. This can help to reduce inflammation and calm your symptoms. They are taken as a pill by mouth. You may not feel their effects until you have taken them for a few months. But you can take them for a long time. You will need to have blood tests every few months to check your liver and blood cell counts.

Side effects may include:

• Nausea.

• Body aches.

• Inflammation of the pancreas (pancreatitis).

• A low white blood cell count.

• Liver problems.

• Low folic acid levels.

• Infection.

• Lymphoma.

• Nonmelanoma skin cancer.

Biologic agents

These kinds of medicines help stop body chemicals that cause inflammation. They are very effective in treating Crohn's disease and decreasing the complications that can happen if Crohn's disease isn't treated. One medicine blocks a chemical called tumor necrosis factor (TNF). The medicine is also known as anti-TNF monoclonal antibodies. Another type of medicine blocks white blood cells from getting into the intestinal tissue and causing inflammation.

New biologics are also being created that target different ways the intestine gets inflamed in Crohn's disease. These medicines may be given different ways. They may be given by vein (I.V.) every 2 to 8 weeks. They may be given with a shot (injection) at different intervals depending on the medicine. These medicines are considered safe, but do have some side effects. For instance, they can put you at risk for infections. Tell your doctor if you have a chronic infection. You will need to be tested for tuberculosis and hepatitis B infection before taking the medicine.

Side effects may include:

• Flushing, chest pain, shortness of breath, hives, or a drop in blood pressure during I.V. treatment.

• Joint and muscle aches.

• A rash.

• A fever.

• Infection.

• Renewal of a previous tuberculosis or hepatitis B infection.

• Lymphoma.

• Skin cancers.

• Liver toxicity.

• TNF-induced psoriasis.

Antibiotics

Antibiotics are not used to treat Crohn’s disease, but are used to treat some complications that may arise. These may be used if you also have an infection, such as an abscess. Antibiotics may be given as a pill taken by mouth. Or sometimes they are put into a vein (I.V.) for more serious infections. Depending on the antibiotic, you may need to stay out of the sun. Or you may need to not drink alcohol.

Antibiotics may be of great help. But they also may cause severe reactions. These can include nausea, vomiting, and breathing problems. Tell your doctor right away if you have numbness or tingling in your hands. Also tell your doctor if your bowel symptoms become worse.

Side effects may include:

• Nausea.

• Diarrhea.

• Headaches.

• Dizziness.

• Dark urine.

• Loss of appetite.

• A metallic taste in the mouth.

• Sensitivity to the sun.

Aminosalicylates

This medicine is also known as 5-ASA. It may be used for mild to moderate symptoms if your Crohn's disease affects your colon (large intestine). The medicine may be taken either orally or by rectum. It works to decrease inflammation in the intestines. However in many cases aminosalicylates are not effective for Crohn's and other medicines are used instead.

Side effects may include:

• A headache.

• Nausea and vomiting.

• Abdominal pain.

• Heartburn.

• Diarrhea.

Small-molecule medicines

These newer medicines are used to treat symptoms (bring your disease into remission) and to maintain remission. They are taken by mouth. They treat your Crohn's disease in different ways, so different small molecules have different side effects profiles.

Managing side effects

Your doctor will explain the side effects of any new medicines. In most cases, side effects are easy to manage. But sometimes they can be so severe that you need to change medicine. Contact your doctor if you have:

• Side effects that are hard to manage.

• Severe side effects.

• Unexpected side effects.