Common Drugs to Treat Crohn’s Disease

Here is a review of the typical drugs to treat Crohn’s disease. There are several categories of drugs that are used to control / reduce the inflammation caused by your Crohn’s. Here is a brief overview of the common drugs to treat Crohn’s Disease. I am currently prescribed Adalimumab (Humira) and Methotrexate (Rheumatrex) to treat my Crohn’s disease. Read more about my battle with Chronic Illness. 

As I am neither a Pharmacist nor a Medical Doctor this is strictly my layperson’s review of the drug treatment options for Crohn’s.  In all case, consult your medical professional for information.

Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

• Sulfasalazine (Azulfidine). Although this drug isn’t always effective for treating Crohn’s disease, it may be of some help for treating disease involving the colon. It has a number of side effects, including nausea, vomiting, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications.
• Mesalamine (Asacol, Rowasa). This medication tends to have fewer side effects than sulfasalazine has but may cause nausea, vomiting, heartburn, diarrhoea and headache. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected. This medication is generally ineffective for disease involving the small intestine.
• Corticosteroids. Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.  Corticosteroids aren’t for long-term use. But, they can be used for short-term (three to four months) symptom improvement and to induce remission. Corticosteroids also may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.

Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than directly treating inflammation. By suppressing the immune response, inflammation is also reduced. Immunosuppressant drugs include:

• Azathioprine (Imuran) and mercaptopurine (Purinethol). These are the most widely used immunosuppressants for the treatment of inflammatory bowel disease. Although it can take two to four months for these medications to begin to work, they help reduce signs and symptoms of IBD in general and can heal fistulas from Crohn’s disease in particular. If you’re taking either of these medications, you’ll need to follow up closely with your doctor and have your blood checked regularly to look for side effects.
• Infliximab (Remicade). This drug is for adults and children with moderate to severe Crohn’s disease who don’t respond to or can’t tolerate other treatments. It works by neutralizing a protein produced by your immune system known as tumour necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract. Some people with heart failure, people with multiple sclerosis, and those with cancer or a history of cancer can’t take infliximab or the other members of this class (adalimumab and certolizumab pegol). Talk to your doctor about the potential risks of taking infliximab. Tuberculosis and other serious infections have been associated with the use of these drugs. If you have an active infection, don’t take these medications. You should have a skin test for tuberculosis before taking infliximab and a chest X-ray if you lived or travelled extensively in areas where tuberculosis has been found. In addition, the Food and Drug Administration has issued a warning that children and adolescents taking infliximab and other TNF inhibitors have an increased risk of cancer.
• Adalimumab (Humira). Adalimumab works similarly to infliximab by blocking TNF for people with moderate to severe Crohn’s disease. It’s prescribed for people who haven’t been helped by infliximab or other treatments. Adalimumab is given as an injection under the skin every other week, which you may be able to administer yourself. Adalimumab may reduce the signs and symptoms of Crohn’s disease and may cause remission. However, adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. Your doctor will administer a skin test for tuberculosis before you begin adalimumab treatment. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose and upper respiratory infection.
• Certolizumab pegol (Cimzia). Approved by the Food and Drug Administration (FDA) for the treatment of Crohn’s disease, certolizumab pegol works by inhibiting TNF. Certolizumab pegol is prescribed for people with moderate to severe Crohn’s who haven’t been helped by other treatments. You initially receive certolizumab pegol as one injection every two weeks. After a few injections, if your doctor determines it’s working for you, you receive one injection a month. Common side effects include headache, upper respiratory infections, abdominal pain, nausea and reactions at the injection site. Like other medications that inhibit TNF, because this drug affects your immune system, you’re also at risk of becoming seriously ill with certain infections, such as tuberculosis.
• Methotrexate (Rheumatrex). This drug, which is used to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used for people with Crohn’s disease who don’t respond well to other medications. It starts working in about eight weeks or more. Short-term side effects include nausea, fatigue and diarrhoea, and rarely, it can cause potentially life-threatening pneumonia. Long-term use can lead to scarring of the liver and sometimes to cancer. Avoid becoming pregnant while taking methotrexate. If you’re taking this medication, follow up closely with your doctor and have your blood checked regularly to look for side effects.
• Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug often used to help heal Crohn’s-related fistulas, is normally reserved for people who don’t respond well to other medications. Although effective, cyclosporine has the potential for serious side effects, such as kidney and liver damage, high blood pressure, seizures, fatal infections and an increased risk of lymphoma.
• Natalizumab (Tysabri). This drug works by inhibiting certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Blocking these molecules is thought to reduce chronic inflammation that occurs when they bind to your intestinal cells. Natalizumab is approved for people with moderate to severe Crohn’s disease with evidence of inflammation and who aren’t responding well to other conventional Crohn’s disease therapies. Because the drug is associated with a rare, but serious, risk of multifocal leukoencephalopathy — a brain infection that usually leads to death or severe disability — you must be enrolled in a special restricted distribution program to use it. This program is called the Crohn’s Disease-Tysabri Outreach Unified Commitment to Health (CD-TOUCH) Prescribing Program.

Antibiotics
Antibiotics can heal fistulas and abscesses in people with Crohn’s disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and suppress the intestine’s immune system, which can trigger symptoms. Frequently prescribed antibiotics include:

• Metronidazole (Flagyl). Once the most commonly used antibiotic for Crohn’s disease, metronidazole can sometimes cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness. If these effects occur, stop the medication and call your doctor. Other side effects include nausea, a metallic taste in your mouth, headache and loss of appetite. You should avoid alcohol while taking this medication.
• Ciprofloxacin (Cipro). This drug, which improves symptoms in some people with Crohn’s disease, is now generally preferred to metronidazole. Ciprofloxacin may cause nausea, vomiting, headache and, rarely, tendon problems.

Other medications
In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following:

• Anti-diarrheals. A fibre supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhoea by adding bulk to your stool. For more severe diarrhoea, loperamide (Imodium) may be effective. Use anti-diarrheal with caution and only after consulting your doctor, because they increase the risk of toxic megacolon, a life-threatening inflammation of your colon.
• Laxatives. In some cases, swelling may cause your intestines to narrow, leading to constipation. Talk to your doctor before taking any laxatives, because even those sold over-the-counter may be too harsh for your system.
• Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve). These are likely to make your symptoms worse.
• Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anaemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anaemia once your bleeding has stopped or diminished.
• Nutrition. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease.  This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term. However, once regular feeding is restarted, your signs and symptoms may return. Your doctor may use nutrition therapy short term and combine it with other medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier for surgery or when other medications fail to control symptoms.
• Vitamin B-12 shots. Vitamin B-12 helps prevent anaemia, promotes normal growth and development, and is essential for proper nerve function. It’s absorbed in the terminal ileum, a part of the small intestine often affected by Crohn’s disease. If inflammation of your terminal ileum is interfering with your ability to absorb this vitamin, you may need monthly B-12 shots for life. You’ll also need lifelong B-12 injections if your terminal ileum has been removed during surgery.
• Calcium and vitamin D supplements. Most people with Crohn’s disease need to take a calcium supplement with added vitamin D. This is because Crohn’s disease and steroids used to treat it can increase your risk of osteoporosis. Ask your doctor if a calcium supplement is right for you.

Reminder: This research was republished from a variety of internet-based sources and may be subject to omission or error.  Consult your medical professional.