Aminosalicylates

Common names include:

• Sulfasalazine
• Mesalamine
• Balsalazide
• Olsalazine
• Rectal administration forms (Rowasa enema, Canasa suppository)

Aminosalicylate drugs help control inflammation in the colon. Precisely how they work is unknown. The active ingredient is released after bacteria in the bowel metabolize the drug.

Possible side effects include:

• Nausea and vomiting
• Heartburn
• Diarrhea
• Headache
• Skin rash

Corticosteroids

Common names include:

• Prednisone
• Methylprednisolone
• Budesonide
• Rectal administration forms (enema, suppository, foam)

Corticosteroids reduce inflammation by suppressing the immune system. They are ordered for more severe episodes of inflammatory bowel disease. They may be taken by mouth, injected, or given by enema or suppository. Do not suddenly stop taking these medicines. Follow your doctor’s instructions for tapering the dose.

Possible side effects include:

• Increased risk of infection
• Weight gain
• High blood pressure
• Mood swings and depression
• Osteoporosis
• Acne

Immune Modifiers

Common names include:

• Azathioprine
• 6- mercaptopurine (6-MP)
• Methotrexate
• Cyclosporine
• Tacrolimus

Immune modifiers block the immune response that helps produce inflammation. These drugs take a long time (months) to work and are usually started with another, more fast-acting drug.

Possible side effects include:

• Bone marrow suppression
• Increased risk of infection
• Nausea and vomiting
• Diarrhea

Antibiotics

Common names include:

• Metronidazole
• Ampicillin
• Ciprofloxacin

Antibiotics are given to treat infections. In Crohn disease and ulcerative colitis, the bowel wall is more susceptible to infection once the lining of the small or large intestine is damaged. Infections are caused when bacteria penetrate the bowel wall. Antibiotics may also be prescribed before bowel surgery. Take antibiotics with food to decrease stomach upset. It is very important that you finish the complete course of therapy. Do not stop taking the antibiotics even if you feel better. Do not drink alcohol while taking antibiotics.

Possible side effects include:

• Upset stomach
• Diarrhea
• Vaginal yeast infections
• Bacterial colitis

Biologic Therapy

• Anti-tumor necrosis factor agents:
  • Infliximab
  • Adalimumab
  • Certolizumab pegol
  • Golimumab
• Integrin receptor antagonists:
  • Natalizumab
  • Vedolizumab

These drugs have been approved to treat severe disease that does not respond to other treatments. TNF-inhibitors is a genetically engineered antibody that binds specifically to tumor necrosis factor (TNF) and blocks its activity in the body. Infliximab is infused into a vein at prescribed intervals. Adalimumab and certolizumab can be given at home.

Integrin receptor antagonists block the effects of leucocytes (white blood cells that cause inflammation). They inhibit a protein that coats the leucocytes and keep them from moving into the tissues.

Possible side effects include:

• Difficulty breathing
• Hives
• Headache
• Infection
• Increased risk for children and teens to develop Hodgkin and non-Hodgkin lymphoma and other types of cancer

Antidiarrheals

Common names include:

• Diphenoxylate-atropine
• Loperamide
• Codeine

These drugs are given to manage diarrhea during active episodes of the disease. They slow movement through the intestines. Although loperamide in liquid form is available without a prescription, the prescription-only capsule form is used for the treatment of inflammatory bowel disease.

Possible side effects include:

• Drowsiness
• Constipation