Crohn’s disease is one type of inflammatory bowel disease (IBD). The other type is ulcerative colitis. Together, these two diseases affect more than one million Americans. The irritation and swelling of IBD causes diarrhea, abdominal pain, appetite loss, fever, and weight loss. When the disease is active, symptoms flare in episodes.
With Crohn’s disease, treatment involves two main components. The first one is avoiding symptom triggers, such as certain foods and stress. The second part is using medications to manage your disease.
There are two main types of drugs doctors use to manage Crohn’s disease. One group of medicines controls inflammation. This relieves symptoms and allows your tissues to heal. The goal is to bring about remission of the disease. The second group reduces symptom flare-ups and extends the time between episodes. The goal is to maintain remission for as long as possible.
Doctors follow expert practice guidelines when choosing Crohn’s medications.
Classes of Crohn’s disease drugs include:
- Aminosalicylates. Salicylates help control inflammation. They treat active Crohn’s disease and may also prevent relapses to maintain remission. Common side effects include nausea, vomiting, diarrhea, heartburn, and headache.
- Antibiotics. These drugs prevent and treat infections and can help abscesses and fistulas heal. Doctors typically use antibiotics during active flares. Side effects depend on the specific drug.
- Biologic Response Modifiers. This class—biologics for short—targets the immune system to decrease its activity. Most Crohn’s patients receiving a biologic drug typically begin with an anti-tumor necrosis factor (anti-TNF) therapy. Biologics can induce and maintain remission of symptoms. Side effects include injection site reactions and flu-like symptoms.
- Corticosteroids. These drugs are powerful anti-inflammatory drugs. Doctors typically use them to get symptoms under control when Crohn’s is active. Some forms can help maintain remission in the short-term, for up to three months. Long-term use can cause problematic side effects.
- Immunosuppressants. This class is also called immunomodulators. They weaken and regulate the immune system to blunt its inflammatory response. These drugs can shorten flares and reduce the amount of corticosteroid you need. They can also help maintain remission. Side effects depend on the specific drug.
Your doctor will monitor your Crohn’s disease after you start treatment. Your doctor will want to know if you continue to have symptoms and how severe they are. This will help your doctor gauge how well your treatment is working. It may necessary to change or add medications to get the best result.
Your doctor has choices to make within each class of Crohn’s disease medicine. Finding the right treatment for you may involve some trial and error.
Here are 10 drugs commonly prescribed for Crohn’s disease:
- Adalimumab (Humira) is a biologic medication. You inject it subcutaneously—under the skin. You will get the first dose in your doctor’s office. After that, the typical dose is every other week. You may need to use it more often in the beginning. This list of FDA-approved biologics is growing, offering more precise therapy to specific subgroups of Crohn’s patients.
- Azathioprine (Azasan, Imuran) is an immunosuppressant. It is a tablet you take either once or twice daily. It can take some time to see the full effect of this medication.
- Budesonide (Entocort EC, Uceris) is a corticosteroid. It comes as a capsule, tablet, and rectal foam. All forms are designed to deliver medication to the intestine. The oral forms remain intact through the stomach and release medicine in the intestines. This non-systemic steroid reduces side effects because 90% of the dose does not reach the rest of the body.
- Ciprofloxacin (Cipro) is an antibiotic. It comes as a tablet and suspension (a type of liquid) for twice daily dosing. There is also an extended-release tablet for once daily dosing.
- Cyclosporine (Gengraf, Neoral, Sandimmune) is an oral immunosuppressant. It comes in different dosage forms and brands with different dosing. Be sure you understand how to take your particular form of cyclosporine. Ask your doctor or pharmacist if you have questions.
- Mesalamine (Apriso, Asacol, Delzicol, Lialda, Pentasa, Rowasa) is an aminosalicylate. It comes in various oral and rectal forms. The rectal forms are usually given at bedtime. The oral forms depend on the particular product. Your doctor or pharmacist can explain exactly how to use your prescription.
- Methotrexate (Rheumatrex, Trexall) is an immunosuppressant. For Crohn’s disease, it is usually a once weekly injection.
- Methylprednisolone (Medrol) is a corticosteroid. The dosing for the oral tablets can range from once a daily to several times a day. Your doctor may also taper down your dose. Ask your doctor or pharmacist about your specific dosing.
- Metronidazole (Flagyl) is an antibiotic. The usual dose is 2 to 3 times a day. It’s important to avoid alcohol while taking this drug. The combination can cause severe stomach upset, headaches, flushing, and sweating.
- Prednisone (Deltasone) is a corticosteroid. It comes as a tablet and an oral solution. The usual dose ranges from once daily up to four times a day with food.
Many people find relief and have success controlling symptoms with Crohn’s medications. However, more than half of people with Crohn’s disease will eventually need surgery to remove affected parts of the digestive tract. While surgery is not a cure for Crohn’s, it can eliminate symptoms for many years.
Researchers continue to study new ways to treat Crohn’s disease. There are several drugs in clinical trials. This includes traditional “small molecules” (in pill form) as well as injectable biologics. Clinical trials can give people access to experimental treatments not currently on the market. If you are interested in participating in a trial, talk with your doctor.
