Most treatments for inflammatory bowel disease (IBD) are either medical or surgical. Many drugs are used in treating both forms of IBD -- Crohn’s disease and ulcerative colitis. When surgery is used to treat IBD, it is more specific to the form of IBD. Surgery is typically only used after all medical options have failed.
Some of the more common drugs used to treat IBD include sulfasalazine (Azulfadine), mesalamine (Asacol, Pentasa), azathioprine (Imuran), 6-MP (Purinethol), cyclosporine, methotrexate, infliximab (Remicade) and corticosteroids (prednisone).
Sulfasalazine (Azulfidine). Sulfasalazine is known as a 5-aminosalicylate acid (5-ASA) compound, a combination of two drugs (sulfapyridine and an aspirin-like compound [5-ASA]) that reduces inflammation in the colon and helps maintain remission. Common side effects include nausea, headache, diarrhea and abdominal pain.
Mesalamine (Asacol, Pentasa) and Olsazine (Dipentum). These newer drugs in 5-ASA class are as effective as sulfasalazine, but tend to have fewer side effects because they do not contain the sulfa component. Instead, the active ingredient (5-ASA) in mesalamine is enclosed in a resin. The resin does not dissolve until the pill reaches the terminal ileum and the colon, which releases the 5-ASA drug directly where it is needed. Mesalamine is most effective in mild or moderate cases of Crohn’s disease and may decrease the chances of a relapse of Crohn’s disease after surgery. A form of mesalamine approved in January 2007 may be taken once daily for ulcerative colitis instead of the several times a day needed for other forms.
Azathioprine (Imuran), 6-mercaptopurine (Purinethol, 6-MP) and cyclosporine A (Sandimmune, Neoral). Azathioprine, 6-MP and cyclosporine are immunosuppressants—a class of drugs that are used to inhibit the immune system. IBD is an autoimmune disease, and while suppressing the immune system may lessen symptoms, it also leaves the body more susceptible to infection. Azathioprine and 6-MP are slow acting, and are often combined with another faster-acting drug, such as a corticosteroid. The action of cyclosporine is faster but it is associated with serious side effects. These drugs are most often used to treat Crohn’s disease and used more infrequently for ulcerative colitis.
Methotrexate (Folex, Rheumatrex). Methotrexate is most often given by injection and tends to induce remission in eight to 10 weeks. An oral version of the drug is also available. Side effects range from mild nausea, fatigue and vomiting to more serious bone marrow and liver conditions. Pregnancy should be avoided by both men and women taking methotrexate because it may cause congenital abnormalities and even death in fetuses. If a patient notices a return of symptoms after switching from the injections to the oral version of methotrexate, they should check with their physician. It could be that the oral dose is not being absorbed well enough by their body. Methotrexate is used in Crohn’s disease, but so far no studies have shown a benefit from its use in ulcerative colitis.
Corticosteroids (prednisone, methylprednisolone, etc.). Corticosteroids are similar to cortisol, a steroid the body produces in the adrenal gland. This fast-acting drug reduces inflammation and is usually prescribed to curb an acute flare-up. Slowly tapering the amount of the corticosteroids taken daily allows the body to begin producing cortisol again on its own. Side effects are common with corticosteroids. While taking corticosteroids, some people can experience an overall sense of wellbeing or euphoria, while others can experience a feeling of agitation. Long-term use is associated with fluid retention and a pattern of weight gain that includes obesity in the trunk, buffalo hump, and round face. Steroids can also increase blood sugars, which can be particularly problematic for people who have diabetes or glucose intolerance. Long term use of corticosteroids can cause osteoporosis. Corticosteroids are used to treat both forms of IBD.
Infliximab (Remicade). Infliximab is stops tumor necrosis factor alpha (TNF-alpha) from being used by the body. TNF-alpha is found in higher than normal amounts in people with IBD. Side effects include abdominal pain, nausea, fatigue, vomiting and rarely, infection. Initially developed for Crohn’s disease, infliximab is now approved to treat both forms of IBD.
Budesonide (Entocort EC). Budesonide is used to treat mild to moderate Crohn's disease involving the ileum and/or the ascending colon. Budesonide is a nonsystemic corticosteroid, and because most of the drug is released in the intestine and not the bloodstream, it causes fewer side effects than other corticosteroids. Side effects include headache, respiratory infection, and nausea. Budesonide is used for both forms of IBD.