Medications for Inflammatory Bowel Disease

Treating IBD with drugs is complicated and might require several "trial runs." It is very important to keep track of how well the drugs are working, what side effects you are having, and report all details to your health care provider.

Most people who have mild to moderate disease are first treated with drugs called aminosalicylates. These medications are aspirin-like medications such as 5-ASA agents (a combination of the drugs sulfonamide, sulfapyridine, and salicylate). They can be given either orally or rectally to help control inflammation. Side effects can include heartburn, nausea, vomiting, diarrhea, and headache. These drugs include mesalamine and sulfazalazine, which have fewer side effects and can relieve symptoms in more than 80 percent of people with ulcerative colitis in the lower colon and rectum. A newer drug form of mesalamine called Colazal is reported to have even fewer side effects.

People with more severe IBD also can be treated with corticosteroids, such as prednisone and hydrocortisone, to reduce inflammation. Side effects of these drugs can include weight gain, acne, facial hair, high blood pressure, mood swings, and a higher risk of infection. A newly approved drug called Entocort EC is a steroid therapy that causes fewer side effects in people with mild to moderate Crohn's disease in the ileum (the last portion of the small intestine that connects to the large intestine or colon).

Drugs that block the immune system's reaction to inflammation are also used to treat Crohn's disease. Side effects can include nausea, vomiting, diarrhea, and higher risk of infection. People with moderate to severe Crohn's disease who do not respond to 5-ASA agents, corticorsteroids, or immune system drugs, or who have open, draining fistulas may be given a drug called infliximab (Remicade). This is the first treatment approved for Crohn's disease and works to remove a protein produced by the immune system that may cause inflammation. Studies are looking at its long-term safety and effectiveness. Azathioprine and 6-mercaptopurine (6-MP) also can be used with steroids, and seem to be the most effective immunosuppressive drugs for the long-term management of both Crohn's disease and ulcerative colitis. They are proven effective for steroid-dependent, chronically active, and steroid-resistant disease.

Antibiotics also are used to treat disease and heal fistulas in the small intestine.

Drugs like antidiarrheals, laxatives, and pain relievers also can be given to help relieve symptoms. Every person should talk with her doctor first before taking these drugs since some may be too harsh for the system or can make symptoms worse.