Several medications can help alleviate symptoms relating to inflammatory bowel disease (IBD), including aminosalicylates, immunomodulators, and biologics.
IBD is a collection of related conditions that affect the digestive tract. The most common are ulcerative colitis (UC) and Crohn’s disease.
Medications can often help relieve symptoms and help prevent disease progression.
This article reviews the medications a doctor may recommend, some examples, how they work, dosage, and side effects. We also look at other possible drugs and alternative remedies.
Aminosalicylates help decrease inflammation in the lining of the gastrointestinal (GI) tract. Their active ingredient is 5-aminosalicylic acid (5-ASA).
Doctors primarily prescribe aminosalicylates for mild to moderate cases of UC. These may help prevent and shorten the duration of flares.
A doctor may prescribe it off-label as the Food and Drug Administration (FDA) has not yet approved its specific use in Crohn’s disease. This is because they may not be as effective in the small intestine that Crohn’s disease affects.
There are several types of aminosalicylates. Some examples include:
How it works
5-ASA works to reduce inflammation in the GI tract. The primary forms include slow-release tablets and suppositories or enemas.
Dosage may vary according to the exact type of aminosalicylate a doctor prescribes, a person’s age, and other factors.
Mesalamine comes in several forms,
- delayed-release capsules: 400 milligrams (mg)
- extended-release capsules: 250 mg, 375 mg, and 500 mg
- delayed-release tablets: 800 mg and 1200 mg
The following are recommended doses for adults and children:
- Adults: 800 mg of delayed-release capsules three times per day for a daily total of 2.4 grams (g) for 6 weeks
- Children: The dose varies by weight and is available for children over the age of 5 years at a maximum daily dose of 2.4 grams, twice a day, for 6 weeks
Though people generally tolerate them well, 5-ASA-containing medications can cause some adverse reactions,
- agranulocytosis, or a low white blood cell count
- kidney issues
- nasopharyngitis, another name for the common cold
- oligospermia, or a low sperm count
- abdominal pain
- aplastic anemia
Medications containing 5-ASA may interact with other medications, such as:
People with certain conditions, such as kidney issues or pregnancy, can discuss their use with a doctor.
Corticosteroids offer systemic immune system suppression to help reduce inflammation responsible for IBD. The medication is nonspecific, reducing the entire system’s response to infections.
Doctors may prescribe corticosteroids for moderate to severe cases of IBD to help suppress the immune system’s response.
How it works
Corticosteroids help to reduce inflammation throughout the body. They are nonspecific, affecting a person’s immune system and not just the inflammatory response relating to IBD.
Dosages for corticosteroids can vary depending on the exact form, severity of the person’s symptoms, and other factors.
Individuals can ask their doctor about their dose and follow all instructions to help reduce the risk of developing adverse reactions.
Some common side effects a person may experience with corticosteroid use include:
- eye issues such as glaucoma and cataracts
- insufficient cortisol hormone production
- Cushing’s syndrome
- cardiovascular disease
- dermatologic adverse effects
- psychiatric disturbances
Immunomodulators help suppress the immune system’s inflammatory response. This helps reduce inflammation responsible for damaging and causing issues in the GI tract, which helps IBD remain in remission.
Doctors may prescribe immunomodulators when a person does not respond to 5-ASA or corticosteroids. T
Though often effective, they can take several months before a person notices the effects.
How it works
Immunomodulators help suppress the immune system’s inflammatory response. Inflammation is what the immune system uses to help fight infection and aid healing, but over time, IBD inflammation can damage a person’s GI tract.
Reducing inflammation can help prevent damage and reduce the frequency and severity of IBD flares.
Side effects can vary, but some common side effects
- damage to the kidneys
Less commonly, they can cause more severe or life threatening reactions in people.
Targeted synthetic small molecules target specific areas of the body, causing IBD symptoms.
These types of medication specifically target the immune system’s inflammatory response. When individuals use them for IBD, they help reduce inflammation which may help alleviate symptoms and help prevent and limit flares.
A doctor may prescribe these for people with moderate to severe disease activity.
How it works
The exact mechanisms can vary according to the medication. They all work similarly in targeting specific parts of the immune system to help reduce inflammation and damage to the intestines.
Dosing and sizes of the medication can vary according to the exact medication a doctor uses. For example, upadacitinib comes in
These medications may cause side effects in people ranging from mild to potentially severe. Some common side effects
Biologics are a type of immunosuppressant that target specific areas of the immune system to help stop its activity. They help stop particular proteins from causing inflammation.
A doctor may recommend biologics for people with moderate to severe IBD.
Some examples include:
How it works
Biologics help block certain receptors throughout the body. This prevents the cell from producing inflammation, which helps prevent damage and IBD symptoms.
Biologics require either an injection or IV drips. A doctor will determine the proper dosage according to the exact medication and needs of the person undergoing treatment.
An individual will require multiple treatments, often over around
Biologics can cause side effects ranging in severity from mild to severe. Some possible side effects
- an increased risk of infections
- GI issues such as nausea or abdominal pain
- reactions to the infusions
- low blood pressure
- flu-like symptoms
- congestive heart failure
- sore throat
- lupus-like symptoms
Additional medications that a doctor may recommend include anticholinergic drugs. These help
IBD can also lead to several infections in the intestines, such as Clostridium difficile. Doctors may treat this complication with oral antibiotics.
Certain lifestyle modifications that people may wish to combine with first-line treatments may
- mind-body medication
- herbal remedies
- nutrition and dietary changes
- exercise regimes
- naturopathic self-help strategies
IBD medications come in several different forms. The number of medications available means a person can get the treatment that helps alleviate symptoms and prevent the progression of the disease.
People can discuss each medication with their doctor to determine the benefits, dosage, and possible side effects.