Medications for Inflammatory Bowel Disease

There are several medications that are used to treat both Crohn's disease and ulcerative colitis. This web page contains only a brief description of available medications and does not include all side effects or complications. Patients with IBD should discuss their medications in detail with their doctor.

Example: prednisone. Steroids have been used for both Crohn's disease and ulcerative colitis for many years. They are used often when there is a sudden increase in symptoms because they work quickly. However, they have many complications such as increasing blood sugar levels, risk of osteoporosis, and risk of infections. We try to decrease steroids as soon as safely possible to use a medication that is safer in the long term. Patients on steroids should not stop them suddenly without discussing with their doctor as the body needs time to adjust to lower doses.

Example: mesalamine. Mesalamine is often used as a first line medication for patients with ulcerative colitis and in certain patients with Crohn's disease. Doctors will be checking kidney tests regularly for patients on mesalamine, but side effects are uncommon. There are many brands of mesalamine with different schedules of dosing and pills. Patient who are having problems remembering to take their pills should discuss this with their doctor.

These medications are often referred to as "immunomodulators." They work by decreasing the number or activity of cells that cause inflammation in your intestines. They have been used for many years in diseases such as rheumatoid arthritis, in patients who have undergone organ transplant, and as chemotherapy for certain cancers. There are uncommon side effects such as inflammation in the liver or pancreas which can be detected by blood tests. There is also a slight increased risk of infection and a blood cancer called lymphoma. Methotrexate is not safe in pregnancy, so patients who have plans for having children should talk with your doctor before using methotrexate. Despite these risks, we use these medications frequently for inflammatory bowel disease because they are safer than chronic or frequent steroids.

These medications are often referred to as "biologics." They all block the effect of a chemical called tumor necrosis factor alpha (TNF-α). By blocking TNF- α, they decrease the activity of cells that cause inflammation. These medications are given either intravenously or by injection. These medications may increase the risk of infection and a blood cancer called lymphoma. Despite these risks, we use these medications frequently for inflammatory bowel disease because they are safer than chronic or frequent steroids.

Natalizumab is a medication that blocks the ability of white blood cells that cause inflammation from reaching the lining of your intestines. If the cells do not reach your intestine lining then the inflammation may be decreased. This medication is given by intravenous infusion. There is an increased risk of infection. A rare, but serious risk with this medication is progressive multifocal encephalopathy (PML). This is from a virus infection in the brain that can be very serious. There has been only one case of PML among patients who received natalizumab for Crohn's disease, and the risk is estimated to be 1 in 1,000.