Professional Documents
Culture Documents
Drugs Used in IBD
Drugs Used in IBD
in IBD
Contents
Introduction
About IBD 04
Why are drugs used in IBD? 06
What types of drugs are used in IBD? 07
Why do some drugs have several names? 08
Why do some drugs come in different forms? 09
Introduction
About IBD
Crohn’s Disease and Ulcerative Colitis (UC) are the two main
forms of Inflammatory Bowel Disease (IBD). In IBD, sections of
the digestive system (which is also known as the gut and which
includes the intestines or ‘bowels’) become sore and inflamed.
Crohn’s can affect any part of the digestive system from the
mouth to the anus. UC affects the rectum and often extends
into the colon (large intestine).
oesophagus
liver
stomach
gall bladder
pancreas
small large
intestine intestine
(colon)
ileum
rectum
anus
6 Drugs used in IBD
Anti-inflammatory drugs:
These stop or damp down the inflammation typical of IBD.
They include:
• aminosalicylates (5-ASAs)
• corticosteroids, often just called steroids
• immunosuppressants
• biologics or ‘anti-TNF’ drugs.
Symptomatic drugs:
These are used to help reduce symptoms such as diarrhoea,
constipation or pain, but cannot reduce the inflammation. They
may include antidiarrhoeals, laxatives, anti-spasmodics, and
analgesics (painkillers).
Antibiotics:
These are used to treat and in some cases prevent bacterial
infections. They tend to be used for Crohn’s Disease rather than
for UC.
Oral Drugs
Most of the drugs used for IBD have a tablet, capsule or
granule form, so can be taken by mouth. Many people with
IBD find this a convenient way to take their medication and
it is easy for a doctor to change dosage levels if necessary.
However, anything taken by mouth will start to dissolve very
quickly, so many of the tablets and capsules have a special
’gastro-resistant’ coating. This makes sure the drug is released
in the right part of the digestive system – usually the small
intestine (small bowel) or large intestine (colon). This is why it
can be important to swallow tablets or capsules whole and
not to break or crush them.
10 Drugs used in IBD
Topical treatment
Taking a drug topically means applying it directly to the
affected part of the body. This can mean that the drug works
more efficiently. Another advantage can be that other parts of
the body are not so readily affected by the drug, and this can
reduce possible side effects.
As for all drugs and medicines, if you are concerned about side
effects or any new symptoms you experience while on 5-ASAs,
contact your doctor or your specialist IBD team.
16 Drugs used in IBD
Corticosteroids (Steroids)
Corticosteroids are often just called steroids. They are closely
related to cortisol, a hormone produced naturally in the adrenal
gland. They act on the immune system (the body’s protection
system against harmful substances) and work by blocking the
substances that trigger allergic and inflammatory responses.
This means that they can reduce the redness, swelling and pain
of the type of inflammation found in IBD.
You will be regularly monitored while you are being treated with
steroids. If you are concerned about any side effects or have any
queries about new symptoms you experience, talk to your doctor
or specialist IBD team. You may also be prescribed supplements,
for example of vitamin D and calcium to help combat the bone
thinning effects of steroids. For more details see our information
sheet Bones and IBD.
Drugs used in IBD 21
Immunosuppressants
As their name suggests, immunosuppressants suppress (reduce
the effectiveness of) the immune system (the body’s protection
system against harmful substances). They are helpful in IBD
because, in doing so they also reduce levels of inflammation.
They have been used to treat IBD for many years and have been
shown to be very effective at reducing symptoms and maintaining
remission in both Crohn’s and UC. However, they act slowly and it
may be several months before you notice any benefit.
These drugs also increase the skin’s sensitivity to sunlight and the
risk of developing some types of skin cancer, so it is best to use
sunblock and to avoid sunlamps or sunbeds.
Methotrexate
Methotrexate is used to help bring about and maintain
remission in people with Crohn’s who are steroid dependent
(cannot stop steroid treatment without having a relapse) and
who do not respond well to azathioprine or 6-MP. Occasionally,
it is used to treat UC, but there is there less evidence of its
effectiveness for this condition.
You will need to have blood tests and tests to check liver and
kidney function before starting methotrexate, and then regular
blood tests while you continue on methotrexate treatment.
Drugs used in IBD 25
Mycophenolate mofetil
Mycophenolate mofetil has been used for many years for cancer
treatment and after organ transplants. More recently it has been
used for people with IBD who do not respond well to other
immunosuppressants or biologics. Some studies have found it
to be effective in bringing about steroid-free remission, but
more research is needed in this area.
Ciclosporin
Ciclosporin is used widely for preventing the body’s rejection of
organ transplants. It is also useful in various conditions caused
by a reaction of the body against its own tissues. In IBD,
ciclosporin is generally used to treat severe UC flare-ups and
may help to avoid or delay surgery to remove the large bowel.
It can be a useful treatment while a slower acting drug, such as
azathioprine, is building up its effectiveness.
You will be given regular blood and kidney function tests while
you are being treated with ciclosporin – probably weekly at first,
and then about once a month.
26 Drugs used in IBD
Tacrolimus
Tacrolimus is similar in action to ciclosporin but may be used
for severe Crohn’s as well as for UC. It works quickly and can
be taken with azathioprine until this slower acting drug
becomes effective. Tacrolimus can be taken orally from the
start so does not necessarily require a hospital stay. It is also
available as an ointment and may be helpful for Crohn’s in the
anal area and UC in the rectum.
“I was advised to go
on infliximab after
a flare-up that lasted
six months. It wasn’t a
decision I took lightly,
but it was the right one
for me, and saved me
from surgery.” Rachel
Drugs used in IBD 27
Infliximab
Currently infliximab is most commonly used to treat severe
active Crohn’s that has not responded to steroids or
immunosuppressants. It may also be used to treat severe
UC as an alternative to ciclosporin.
For more details on infliximab and how it works, see our drug
treatment information sheet, Infliximab.
Adalimumab
Adalimumab is a more recent synthetic (man-made) anti-TNF
drug. It is mainly used for severe Crohn’s, although it is licensed
to treat UC in some circumstances.
Symptomatic Drugs
There are a number of drugs available, often ‘over the counter’
(without a prescription), which can be very effective at treating
symptoms such as diarrhoea, constipation and pain. These are
known as symptomatic drugs. However, they do not reduce the
inflammation causing these symptoms.
Antidiarrhoeals
Codeine phosphate, loperamide (Imodium, Arret), and
diphenoxylate (Lomotil) are all drugs which reduce diarrhoea by
slowing down the contractions (muscle activity) of the gut, so
food takes longer to pass through your system. This allows more
time for the water produced by the digestive processes to be
reabsorbed by the colon, and for the stools to become firmer
and less urgent.
Bulking agents
Bulking agents or ‘bulk formers’ contain a water absorbent plant
fibre – usually ispaghula or stercula. Popular brands include
Fybogel, Isogel, and Normacol. These come as granules which,
when taken with plenty of water, swell up inside the bowel and
thicken liquid or soften hard stools. The fibre also provides enough
bulk for the bowel to work normally.
Laxatives
Constipation can also be a symptom of IBD, especially of proctitis
(inflammation in the rectum). Laxatives help to relieve constipation.
Osmotic laxatives, such as Movicol, which contain a compound
known as macrogol, are usually considered the best type of
laxative for people with IBD. These increase the amount of water
in the large bowel and make the stools softer and easier to pass.
However, laxatives can also cause wind and stomach cramps,
especially at the start of treatment.
Anti-spasmodics
Anti-spasmodics such as mebeverine (Colofac), hyoscine
butylbromide (Buscopan) and alverine citrate (Spasmonal) reduce
painful gut cramps or spasms by relaxing the intestinal muscles.
These medicines are most likely to be recommended for people
with Irritable Bowel Syndrome (IBS), but they may also be helpful
for the IBS-like symptoms sometimes experienced by people
with IBD.
Analgesics (painkillers)
If you need to take over the counter painkillers it is probably best
to avoid ibuprofen and diclofenac. These are what are known as
non-steroidal anti-inflammatory drugs (NSAIDs). While they can
be very effective for pain in the joints and spine, which may affect
some people with IBD, there is some evidence that they may make
other IBD symptoms worse or possibly trigger a flare up. Some
people may also be affected by aspirin, so for simple pain relief
paracetamol is probably the safest option for people with IBD.
If you find you have ongoing problems with pain and need to keep
taking painkillers, talk to your doctor about your symptoms as
other treatment may be more appropriate.
Drugs used in IBD 33
Antibiotics
Antibiotics kill or stop the growth of bacteria, and are
sometimes used for IBD.
Metronidazole (Flagyl)
This is the most commonly prescribed antibiotic for Crohn’s
Disease. It is usually taken as a tablet, but it can be taken as
a suppository or be given by injection. Side-effects may
include nausea, lack of appetite and a metallic taste in the
mouth. More rarely, long term use can cause nerve damage
and a tingling in the hands and feet.
Ciprofloxacin
Ciprofloxacin is also used for the treatment of Crohn’s and has
been found to be as effective as metronidazole, with fewer
side effects. It too is normally taken as a tablet, but can be
given by injection. Common side effects include nausea and
diarrhoea, and it may interact with some of the other
medications used for IBD.
Drugs used in IBD 35
If you are prone to forgetting things like taking tablets, try and
make taking them part of your daily routine, like brushing your
teeth. Our leaflet, Staying well with IBD has some other
suggestions of ways to remind yourself.
38 Drugs used in IBD
You can also talk to your local pharmacist, who has professional
knowledge and should also be able to answer any questions
you have about any drugs and medicines.