Patients with Crohn’s disease and ulcerative colitis may respond differently to the various drugs in this class, so treatment regimens are unique to each individual. Most people are first treated with drugs containing 5-ASA, or 5-aminosalicylates, a substance that helps control inflammation. Mesalamine (Asacol, Pentasa, Lialda, Apriso) is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other 5-ASA-containing drugs, such as sulfasalazine (Azulfidine, Sulfazine), olsalazine (Dipentum), or balsalazide (Colazal, Giazo) Pentasa. Possible side effects of mesalamine-containing drugs include nausea, vomiting, heartburn, diarrhea, and headache.
Steroids. Corticosteriods are one of the oldest treatments and provide very effective results. Prednisone is a common generic name of one of the drugs in this group of medications. In the beginning, when the disease it at its worst, prednisone is usually prescribed in a large dose. The dosage is then lowered and usually discontinued once symptoms have been controlled. These drugs can cause serious side effects, including greater susceptibility to infection. Budesonide is another steroid drug that has less systemic effects.
Immune system suppressors. Drugs that suppress the immune system are also used to treat Crohn's disease. Most commonly prescribed for refractory inflammatory bowel disease are 6-mercaptopurine (6-MP) or a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person's resistance to infection.
Biologics. Infliximab (
Remicade) is the first of a group of medications that blocks the body's inflammation response. The FDA approved the drug for the treatment of moderate to severe Crohn's disease and ulcerative colitis that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas. Other drugs in this class include adalimumab (Humira), vedolizumab (Entyvio), natalizumab (Tysabri), golimumab (Simponi), and certolizumab pegol (Cimzia). Remicade, Entyvio, Humira, and Simponi are the biologics FDA-approved for use in those with ulcerative colitis. Biologics can have serious side effects and are usually used when more conventional therapy fails.
Antibiotics. In Crohn’s disease antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor most commonly prescribes ciprofloxacin or metronidazole.
Anti-diarrheal and fluid replacements.
Diarrhea and abdominal cramps are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.