When medications for Crohn's Disease (CD) and Ulcerative Colitis (UC) are prescribed, it is very important that you follow instructions closely:
Please call the IBD Center if you have questions about your medications, experience a side-effect or run out of pills.
If you do not wish to take a medication or cannot tolerate it, let us know. It is not a good idea in general to stop a medication without informing us.
It is very important to know what IBD medications you are taking and the dosages. You may wish to carry with you a list of your medications with dosages.
It is also very important that you understand the side effects that can happen with medications for CD and UC. Below is information about the more common side effects of some medications for IBD.
This information does not include all possible side effects and not all medicines used for IBD are listed. Specific questions about medications should be discussed with your doctor or GI coordinator.
5-aminosalicylates (5-ASA)
Examples: mesalamine, sulfasalazine, Asacol, Pentasa, Rowasa, Canasa, Lialda These medications are given often and in large doses for IBD. They are quite safe and for most people, no side effects occur. Rarely, they can cause rash, hair loss, diarrhea, abnormal blood counts, pancreatitis or kidney dysfunction.
Antibiotics Examples: Cipro, Flagyl (metronidazole), Levaquin, rifaximin Antibiotics are used primarily to treat Crohn’s disease and various kinds of diarrhea related to IBD.
Most antibiotics are well tolerated but metronidazole can cause:
nausea
metallic taste in the mouth
numbness or tingling in the hands and feet (neuropathy). You must stop metronidazole and call your doctor if you experience symptoms of neuropathy.
Steroids – prednisone, budesonide (Entocort)
Prednisone preferably is given short-term (2-3 months) for active IBD. It works for most people but can cause many side effects when used at higher doses chronically.
These include:
weight gain
high blood pressure
bone loss (osteoporosis)
cataracts
glaucoma
diabetes and others
A rare side effect is osteonecrosis of the hip joint. It is important to reduce the dose and stop prednisone when your doctor advises, but other medicines are usually needed to keep you in remission. Your GI doctor will work with you to minimize the potential for side effects while you are on steroids.
Azathioprine, 6-mercaptopurine
Examples: Imuran, Purinethol, Azasan
These medicines are called immunomodulators and are often given to keep you in remission and get you off steroids. About 2% of people on these medicines develop pancreatitis, an inflammation of the pancreas gland causing mid-abdominal pain, nausea and vomiting. If severe, pancreatitis may require admission to the hospital. Another side effect is a drop in your white blood cell count. In less than 1% of people this can happen suddenly soon after starting the medicine.
It is very important that you have your blood drawn every 2 weeks during the first few months after starting these medications. Once you are on a stable dose, you must have blood drawn for a complete blood count every 3-4 months as long as you are taking these medicines. Lastly, these can rarely cause other side effects such as:
rash
hair loss
abdominal pain
abnormal liver tests
nausea
A related medicine called methotrexate rarely causes liver or lung fibrosis (scarring).
Infliximab (Remicade), adalimumab (Humira), certolizumab (Cimzia)
These are given intravenously or subcutaneously. They work by suppressing your immune system. If you have ever been exposed to tuberculosis (TB) in the past and have a latent infection, these medicines may reactivate TB.
There is a low risk for other infections such as sinusitis, pneumonia, or fungal infections. Infusion reactions occur in 8-10% of patients who get Remicade. These reactions may happen while the medicine is being delivered through the IV or up to 2 weeks after.
You may develop:
fever
rash
chest pain
shortness of breath
Lastly, there have been rare reports of lymphoma and liver disease in patients taking these drugs. Though very rare, there have been deaths as a result of side effects to these medications.