Drugs in common use are here listed in alphabetical order for ease of reference.
Acetarsol may be provided by the pharmacies of certain specialist hospitals but is not available on general prescription. It is a substance derived from arsenic. However, although arsenic is a poison, it has been found to be very effective in some cases of resistant proctitis.
Acetarsol has proved safe and effective in clearly defined doses. Some cases of poisoning have occurred with prolonged courses (greater than 4 years in both cases) or with large doses (3.5-7.9 g). Levels in the blood and urine may be initially high but rapidly fall (usually after 1 week) as the lining of the rectum heals. When treatment is stopped there should be no further trace of the drug after approximately 4 weeks
This treatment is usually only prescribed when the standard treatments for colitis, (mesalazine or steroids) have failed to settle the symptoms.
The treatment should be prescribed by your specialist and taken according to instructions. Suppositories will usually be prescribed as 250 mg morning and evening, for up to 1 month. The suppositories should be lubricated with a little K Y jelly or water and then inserted into the back passage.
Acetarsol is generally safe to use if taken correctly according to your doctor’s instructions. Possible side effects may occur and would be related to arsenic toxicity.
Adalimumab is a fully human monoclonal antibody against Tumour Necrosis factor – alpha (TNF-a), the chemical which is at the heart of many inflammatory diseases (See infliximab). When successful it may induce and prolong remission of CD. It use in CD is relatively new but it is also valuable in the treatment of rheumatoid arthritis. It has the advantages that the patient may be able to give his own injections at home at intervals of one to two weeks.
Like other monoclonal antibodies against TNF-alpha it may reduce defences against infection. Patients must be checked for tuberculosis before starting treatment and it must not be given to pregnant or breast-feeding women. It may make congestive cardiac failure and multiple sclerosis worse. It must be used with care in patients with chronic infection such as leg ulcers, perianal disease and indwelling urinary catheters.
Common side effects include pain at the injection site, respiratory infections, nausea and abdominal pain, headache and rash. Systemic infections e.g. candidiasis and influenza may occur. Rarely, treatment with adalimumab may lead to the development of lymphoma, lupus or neurological disease.
Adalimumab has been shown to be effective in cases which have failed to respond to other treatments but your doctor will decide if it is appropriate to your case.
Asacol is mesalazine in a resin coated designed to release the active ingredient 5-Aminosalicylic acid (5-ASA) in the terminal ileum where the pH is above 7. The active ingredients are then dispersed throughout the colon.
Asacol is used in the treatment and maintenance of mild to moderately acute ulcerative colitis and CD
Asacol is presented in several forms:
The above medications will be prescribed according to the site and severity of the inflammation and may be used in combination.
The enemas are used to act directly on inflammation in left-sided disease and suppositories for rectal inflammation. Once the symptoms have been controlled, you will be given a lower maintenance dose. Although you might feel better it is important to continue taking the medication as instructed to prevent the symptoms from coming back.
Asacol should not be taken if you are allergic to aspirin. It is not recommended if the kidneys are not working properly. Its effect may be reduced by medications, which alter the pH of the intestine and affect its absorption e.g. lactulose.
Asacol is safe to use during pregnancy and it is better for both you and your baby that active disease is treated vigorously and effectively. The lowest effective dose will always be used. Low levels of mesalazine have been detected in breast milk, but it is safe to continue.
Asacol is generally well tolerated but, if side effects were to happen, these could include:
It may also cause a worsening of the colitis in a very few sensitive people. Impairment of kidney function occurs very rarely but everyone on mesalazine should have an annual blood test to check their kidney function.
Side effects tend to be related to the dose and can be minimised by gradually building it up. If side effects continue, the drug should be stopped.
*Important note
If you have any unexplained bleeding, bruising, a sore throat, fever or generally feel unwell whilst taking the medication, you should stop immediately and see your doctor for a blood test and further advice.
You may see what appears to be the tablet in your motions but should be reassured that the active molecules have usually been released, leaving the resin case. If you consistently see the grey powder still contained within the case, it will probably be worthwhile switching to a different 5-ASA preparation.
Azathioprine is a drug that affects the immune response in the body (i.e. an immunosuppressant).
The main use is in organ transplantation to prevent rejection of the donor organ. However, it has proved beneficial in patients with severe chronic inflammatory bowel disease which has not responded to steroids alone, or in patients who are dependent on high dose steroids to control symptoms. It is useful in those patients who frequently relapse on reducing the dose of steroids and thus has a steroid sparing effect.
It is taken as a tablet that must be swallowed whole with plenty of water. The dosage is calculated according to your body weight – usually 2 mg per kg, however your doctor will tell you the correct dose for you. Some people have lower levels of the enzyme which metabolises azathioprine (TPMT) and they will be given lower doses.
Recently there has been interest in the possibility of reducing the risk of side effects on azathioprine by giving a small dose (one quarter of the normal level) together with another drug, allopurinol which is widely used to treat gout, but which reduces the breakdown of azathioprine and thus promotes its therapeutic effect. Allopurinol must never be taken by persons on full doses of azathioprine as this could lead to the build-up of toxic levels.
The tablets may be taken altogether, although taking them in divided doses and after meals may reduce any associated nausea.
You will not usually notice any effects straight away, as it can take up to 6 weeks before it begins to work and the real benefits may not be noticed for 3 months or more. For this reason treatment is often commenced in conjunction with oral steroids for more immediate relief of symptoms with the dose gradually being tapered as the azathioprine begins to exert its effect.
Due to the potential risk of treatment on the bone marrow and the liver, it is extremely important to have regular blood checks whilst taking the treatment. Full blood counts and liver function tests should be taken on a weekly basis for the first 2 months, then 3 monthly thereafter whilst taking the treatment.
Results should be recorded in the monitoring book given to you by the doctor. Tests can be carried out at the hospital or GP surgery, but it is important that the doctor, or nurse, tells you that it is safe to continue.
You should not take this drug if you have previously had a reaction to this or to 6 mercaptopurine.
If you are considering becoming pregnant, or become pregnant whilst taking azathioprine treatment, speak to your doctor or nurse as soon as possible. Your doctor may well tell you to continue t, particularly if you have troublesome disease that has only been under control on this treatment. If you are planning a pregnancy, and you have been in remission for some time, you may be advised to try stoppingazaathioprine before trying to become pregnant. However, there is as yet no definite evidence that azathioprine, when used to treat IBD, increases the risk of damaging the baby.Nevertheless, treatment should not be initiated during pregnancy.
Azathioprine should be stopped in all but minor infections as the body defences may be reduced and delay your recovery or cause a worsening of the condition. Speak to the nurse or doctor before stopping any treatment and you will be advised when it is safe to restart.
Azathioprine can be very effective in providing remission from the symptoms caused by inflammatory bowel disease, and in allowing smaller doses of steroids to be used effectively whilst reducing the risk of relapse and steroid induced side effects. However it is possible that some side effects may occur during treatment. Symptoms, such as diarrhoea, nausea, mild aches and pains may occur initially but should settle within 2 weeks. Others, which are potentially more serious, may occur. These may include some of the following:
These may be due to a hypersensitivity reaction and you may need to stop the treatment. You must contact your doctor or IBD nurse immediately for further advice.
Other reactions may occur such as:
These may respond to a dose reduction or temporarily stopping treatment and reintroducing at a lower dose.
It may rarely cause inflammation of the pancreas or lungs. This is reversible on stopping treatment, but the drug should not be restarted on recovery.
Although these side effects may sound quite alarming, many patients manage to take the drug safely with little, or no, trouble. You should be reassured that you will be monitored closely whilst taking this treatment and that if side effects do arise, they will be dealt with accordingly.
Your compliance with the monitoring programme is essential in the safety of your treatment.
Azathioprine may react with other drugs and it is therefore important that you tell your doctor about any other tablets you may be taking. You should not start any new medication before discussing this with your doctor or IBD nurse first. Interactions include:
These are bile acid sequestrants, i.e. they ‘mops up’ excess bile salts.
Principally to control diarrhoea caused by excessive amounts of bile salts spilling over into the large bowel and irritating its lining.
This can occur if the terminal ileum, where these salts are normally absorbed has to be removed due to CD which is not responding to medical treatment.
Cholestyramine is a powder which is dissolved in water and taken as a drink. Colestipol comes as granules to be taken with liquid.
Supplements of the vitamins A, D, E and K may need to be taken ifthese preparations have been used for a long time in high doses (i.e. 3 or more sachets daily).
If you take any of the following drugs:
They should be taken either 1 hour before or 4 – 6 hours after taking It may be used during pregnancy and breastfeeding if the doctor considers that the benefits outweigh any potential harm that may be caused.
If these resins are taken for a long period of time, it can lead to delayed clotting of the blood due to a lack of Vitamin K.
They can also cause constipation, but this usually resolves on continued usage.
Colifoam is a steroid foam (hydrocortisone) in an aerosol canister which delivers a metered dose.
It is used in the treatment of mild to moderate UC affecting the rectum and sigmoid colon. The foam acts directly on the area of inflammation.
Insert lubricated spout into the back passage whilst lying on your left hand side and apply 1-2 metered doses as directed by the doctor
If you forget to apply a dose do not worry, but be sure to apply the next dose at the right time. You must complete the course that the doctor has prescribed and not stop the medicine because you are feeling better.
It is usually used 1-2 times daily for 2-4 weeks, then on alternate days before stopping.
Colifoam may be used in small amounts for short periods of time in pregnancy and in children with inflammatory bowel disease.
It should not be used if:
Side effects are relatively rare as the steroid drug acts locally on the site of inflammation and very little is absorbed into the body.
These are groups of steroid hormones, (e.g. cortisol); produced by the outer layer (cortex) of the adrenal glands, which are located on top of the kidneys.
Synthetic preparations are usually more powerful than the normally occurring hormones and are given to enhance their effect on disease in the body. These include:
They are used mainly to control inflammation and the immune response in the body. They can also be used to replace low levels of naturally occurring steroids in the body when production of these is insufficient.
They can be given in various forms depending on the severity of the condition and the site of the disease:
1. Tablet (e.g. Prednisolone, Dexamethasone)
This is swallowed and may be sugar coated or uncoated. It is absorbed through the stomach into the bloodstream and so has an effect throughout the body.
2. Injection (e.g. Hydrocortisone, Dexamethasone, Methylprednisolone)
The steroid is injected into a vein or muscle to allow a more rapid effect. Again, it has effects throughout the body. This form of treatment is used in severe cases of inflammatory bowel disease.
3. Topical preparations
These are applied directly to the area to be treated, thus causing minimal effects on other areas of the body. As treatment is direct, dosage is usually lower. Examples of these preparations include:
At the beginning of treatment it is usual to give a large dose to achieve remission. Once the disease is under control the dosage can gradually be reduced to prevent side effects.
You should not suddenly stop corticosteroids if you have been taking them for more than a few days as they usually cause the body’s own adrenal gland to stop working. Sudden withdrawal may result in steroid deficiency, which can be dangerous, causing fatigue, vomiting and diarrhoea. Your doctor will advise you on how to reduce the dosage safely.
You should avoid contact with chicken pox or Herpes zoster (shingles) whilst taking treatment and for three months after stopping it. If you should come into contact with these diseases, you may need to be given an injection of immunogloblins (antibodies against shingles or chicken pox) as your own immunity may be greatly reduced due to the steroids. If you have had the diseases or have been immunised against them you need not worry.
You must let your doctor know all the medications you are taking as steroids can also have an effect on these, especially:
Studies have shown that the reported incidence of increased risk of spontaneous miscarriage, stillborn babies and premature labour is likely to be secondary to the disease rather than to the treatment. Active disease itself can be harmful to the foetus therefore controlling the disease may outweigh any potential side effects from these drugs.
There are many side effects, which may occur from taking steroids, and the aim of treatment is to achieve maximum benefit with minimum side effects. Side effects most often occur when doses greater than 12.5 mg are given daily for prolonged periods. The doctor should monitor such doses very closely.
Courses of drugs tend to be short and sharp and often in combination with other drugs in order to further reduce the likelihood of long-term side effects. However, some of the side effects, which may occur, could include:
Entocort is a capsule containing Budesonide which is a glucocorticosteroid, previously successful in the treatment of asthma in an inhaled formula due to its anti-inflammatory properties. It is released above pH 5.5, (i.e. out of the stomach), and its optimum effect is in the terminal ileum and caecum (60-70%) before being distributed throughout the large intestine. It has the advantage over other corticosteroids of being broken down almost completely on its first pass through the liver, and thus it is much less likely to get into the general circulation and cause side-effects. On the other hand it is therefore only effective in treating IBD in that limited part of the bowel where it is released, that is the ileo-caecal area.
Trials have shown it to be as effective as oral prednisolone in causing a remission of mild to moderate CD affecting the ileum and/or ascending colon. Trials for usage in long-term maintenance are planned but, as yet, it is indicated for the acute phase only.
Entocort is presented in a hard gelatin capsule protecting it from the acid in the stomach and allowing a controlled release. The tablets should be swallowed whole with plenty of water and is generally unaffected by food.
If taking cholestyramine (Questran) absorption may be affected, therefore it should be taken one hour before this.
Blood levels of Entocort are significantly lower than they would be with conventional steroid treatment but should still be used with caution in certain circumstances, and you should let the doctor know if you have any of the following:
You should let the doctor know if you are pregnant or breastfeeding. It is not known whether Budesonide passes into breast milk.
No studies have been performed on usage in childhood CD
Steroid side effects of Budesonide have been reported to be very much lower than conventional steroids as the dose is delivered in a controlled release and has a topical effect on a specific site (greater than 95% of the drug), rather than being absorbed into the blood stream first and thus having a general effect on the body. Once broken down in the liver, the amount of steroid available in the system is less than 10% of the original drug. Side effects are less than half those seen with conventional steroids.
However, some adverse reactions have been reported other than effects of steroids, and these could include:
However, many of these problems were also found in placebo treatment during clinical trials.
Fybogel is made up of granules of effervescent i ispaghula husk. It is free from gluten and sugar. It is available in plain, lemon or orange flavours.
It is a bulk-forming laxative used to relieve constipation. It works by increasing the mass of stool which then presses against the intestinal wall stimulating peristalsis, thus promoting a bowel motions.
It may take a few days before it is fully effective and sufficient bulk has built up to cause a bowel motion. This is quite usual and you should continue with the treatment.
One sachet is emptied into a large tumbler full of water, rapidly stirred and drunk immediately, (if left to stand it will solidify into a thick gel). For greater effect a further glass of water should follow.
The sachets should be taken twice daily following breakfast and the evening meal.
The dose may be adjusted once a regular soft stool is achieved, i.e. one sachet daily or 1-2 sachets on alternate days, and continued as necessary.
Insufficient fluid intake with Fybogel can occasionally lead to obstruction of the bowel. It should not be taken immediately before bedtime when fluid consumption is normally considerably reduced.
As Fybogel is sometimes fermented by bacteria in the colon it may lead to flatulence and bloating.
It may also cause:
Tumour necrosis factor alpha (TNFa) is a potent pro-inflammatory cytokine – a substance produced by the white blood cells in response to inflammation leading to ulceration & tissue damage. Infliximab is an antibody (a special kind of protein), which binds and neutralises TNFa.
Infliximab is licensed for the treatment of moderate to severely active CD not responding to steroids and/or immunosuppressants, or for fistulizing disease
It is given as an infusion into the vein over a period of approximately two hours. During this time you will be closely monitored in case of possible infusion reactions. It will be necessary to check the blood pressure, pulse, and temperature at half hourly intervals during the infusion and for around one or two hours afterwards.
The dose is calculated according to body weight (5 mg/kg). It is given as a single infusion or may be repeated in eight weekly cycles if signs of relapse occur.
To heal fistulae the same dosage is given, but repeated at two and six weeks after the initial infusion.
Recent research has shown that infliximab is even more effective if it is given at regular intervals, every eight weeks for a full year.
TNFais produced very early on in the so-called inflammatory chain and is responsible for many other events that occur afterwards. Thus, if TNFa is blocked, events leading to tissue damage may be prevented.
Evidence of a response to the treatment, with a reduction, or complete resolution of symptoms, is usually noted at around two to four weeks after the infusion, the benefits lasting for some eight to twelve weeks. A repeat infusion at this time can restore the initial benefits or enhance the effects if only a partial
response has been achieved. For some patients a single infusion may be all that is needed.
The answer is yes. Despite very promising results Infliximab is not a cure for CD. Once remission has been achieved this will be maintained by your previous medication, diet, or a combination of both.
Research has shown that patients taking drugs such as azathioprine, have a reduced incidence of relapse following treatment with Infliximab.
Infliximab is a new treatment for CD and therefore the full safety profile remains unclear. However patients have been followed up in clinical trials for a period of two years in order to determine safety of treatment and re-treatment.
Patients with heart failure should not takeinfliximab. As TNFa is normally produced as part of the body’s defence against infection, infliximab may allow infections to become more severe. This is particularly important in the case of tuberculosis (TB). Some people with past exposure to TB may find that the disease becomes reactivated, and all patients should have tests to exclude tubercule before treatment with infliximab is started. Sepsis may also occur. If you have lived in a region where histoplasmosis is common or if you have any disease that affects the nervous system you should tell you doctor before starting treatment.
Side effects which have occurred during or shortly after the infusion because of hypersensitivity have included:
Infusions may need to be slowed down, discontinued or antihistamine treatment given.
Other reported reactions during clinical trials include:
Other effects may occur due to an increased susceptibility to infection or masking of the normal signs of infection due to the blocking of TNF. Speak to your doctor or nurse immediately if you are concerned about any possible side affects you may be experiencing.
Occasionally patients may develop antibodies to the antibody, which may cause allergic reactions. These will need to be dealt with accordingly and treatment with Infliximab stopped.
During clinical trials, one case of lymphoma (cancer of the lymph glands) has been reported nine months after treatment in a patient with longstanding CD and a long history of treatment with steroids and immunosuppressants. This may have been due to the illness itself rather than Infliximab as it is well within the reported incidence of lymphoma in CD. However, this highlights the need for continued monitoring.
Infliximab should be reserved for unresponsive disease.
Although, these potential side effects might seem quite alarming, this treatment is prescribed for difficult disease which needs to be controlled in order to prevent further complications from developing. If you are anxious about any aspect of your treatment discuss these with the doctor or nurse as soon as possible.
Infliximab must not be given if there is evidence of infection or the presence of abscesses, or if there have been hypersensitivity reactions on previous infusions.
6-mercaptopurine (6-MP)(Puri-Nethol)
This drug is a metabolite of azathioprine – indeed azathioprine is converted to 6-mercaptopurine in the body. For this reason some physicians prefer to use 6-MP rather than azathioprine itself. It is given in a slightly lower dose (1 – 1.5 mg/kg body weight each day) and some believe it is less likely than azathioprineto produce side-effects. The clinical indications for use are identical to azathioprine and the precautions and possible side-effects are also the same.
Methotrexate is a drug that affects the immune system (i.e. an immunosuppressant) and is useful for its steroid sparing effect.
The main use is in treating some types of cancer, but it has been used in chronic inflammatory conditions, such as rheumatoid arthritis, with very beneficial effects. Its use in other conditions, such as Crohn’s disease and ulcerative colitis has also proved beneficial in some cases, particularly those cases not responding to other immunosuppressants.
It is usually taken in tablet form on a weekly basis. It should be taken with or after food. The tablets should be swallowed whole and not crushed or chewed. Methotrexate can also be given by injection.
The initial starting dose will usually be 7.5 mg weekly. This may be increased by 2.5-5 mg on a monthly basis up to a maximum of 20 mg weekly, depending on how you respond.
It is possible to have a course of 3 treatments in divided doses of 2.5 mg at 12 hourly intervals once weekly. This may be better tolerated if side effects have occurred. A test dose of 5-10 mg may be given one week prior to the start of your treatment to see if any reactions occur.
The lowest effective dose will be given to you but you will not notice a difference straight away. A response can usually be expected by 4-6 weeks, but this may take as long as 12 weeks.
Due to the potentially serious adverse effects on other systems in the body, it is extremely important that you have regular blood tests whilst taking the treatment. The type and frequency of monitoring should be as follows:
NB: Any abnormality on testing should be reported to the doctor or IBD nurse immediately for further advice.
Methotrexate should not be used if you have kidney problems or pre-existing liver disease. It is known to have harmful effects on ova and sperm; therefore it is extremely important that reliable contraceptive methods are used during treatment and for at least 6 months afterwards. It must never be taken in pregnancy or by breast-feeding women.
It is possible that some side effects may occur during treatment. These may include some of the following:
Less commonly other effects may occur as a result of bone marrow suppression, such as:
Rarely, it may cause liver fibrosis/cirrhosis. If alcohol is avoided this has been proven to be rare. Acute inflammation or chronic fibrosis of the lungs may occur. If you get a dry cough in association with breathing difficulties and fever, contact the doctor immediately for further assessment.
Fertility may be affected, but this is reversible on stopping treatment.
Although this list of side effects may seem quite alarming, it does not mean that you will have all, or indeed any of them. The fact that your doctor has decided that this treatment is required to help control your symptoms means that you have a difficult disease that needs strong medication to keep it under control and therefore reduce the risks of complications and possibly avoid the need for surgery.
You should be reassured that you will be closely monitored whilst you are taking the treatment and if any side effects do arise that these will be dealt with accordingly.
Methotrexate interacts with some drugs so it is important that you tell your doctor about all your other medications so that these are taken into account. The following should be avoided whilst taking methotrexate:
There may be other important drugs to avoid so please speak to your doctor before starting any new treatment.
Celevac is a tablet of methylcellulose (a plant fibre), which absorb water and swell into a soft gel.
It is used as a ‘bulking’ agent in the treatment of diarrhoea or constipation often associated with inflammatory bowel disease. It has the advantage of not being fermented by colonic bacteria and is therefore less likely to lead to excess wind.
Tablets are usually chewed and swallowed with varying amounts of water depending on usage for constipation or diarrhoea:
a) Constipation
3-6 tablets twice daily with a large amount of liquid (at least 300 ml). This forms a soft bulk in the bowel which is easy to pass. The dose can be reduced when normal bowel movements occur.
b) Diarrhoea
3-6 tablets taken twice daily with minimal liquid (i.e. enough to swallow the tablets with). Liquid should be avoided for half an hour before and after each dose. The dose can be adjusted to give the motions the required consistency.
It may be used in the same way to keep control of colostomies and ileostomies
Control of colostomy and ileostomy is as above.
You should not take Celevac if you have a narrowing of the bowel which may obstruct with treatment.
There are no reported side effects from taking Celevac, but abdominal swelling may occur if levels build up in the bowel due to overdosing.
Flagyl is an antibiotic used to treat infections caused by anaerobic bacteria, (i.e. bacteria not requiring oxygen to survive), particularly in the bowel.
It has been shown to be effective in the treatment of anal complications of CD, such as infected fistulae and fissures. It has also been shown to be as effective as sulfasalazine in reducing mild to moderate inflammation in CD.
It can be taken as a:
Flagyl interacts with certain drugs such as:
Therefore careful monitoring during treatment may be required.
You should not drink alcohol when taking Flagyl as Flagyl blocks the breakdown of alcohol in the liver, and this can lead to very unpleasant symptoms.
Studies have shown that the drug has no adverse effect in pregnancy on the developing foetus and the small amounts found in breast milk are far less than the normal paediatric dose and is unlikely to cause harm.
Most people are able to take Flagyl without major problems, but some of the following side effects may occur:
Side effects are usually reversible on stopping the drug, although peripheral neuropathy can occasionally persist.
Mycophenolate is a drug that affects the immune response in the body (i.e. an immunosuppressant).
The main use is in organ transplantation for prevention of donor organ rejection. It is being increasingly used to treat severe active inflammation in the bowel that does not respond to anti-inflammatory (5-ASA) drugs and also in steroid refractory or dependent disease. It is also used for patients who are allergic or sensitive to Azathioprine.
It is taken by mouth in either tablet or capsule form. The dose is usually 1 g twice daily.
Due to the potential risk of bone marrow suppression it is extremely important to have regular blood checks whilst taking the medication. The type and frequency of monitoring should be as follows:
FBC+LFT’S on a weekly basis for 1 month, then 2 weekly for 2 months and monthly thereafter if all remains well during the first year.
NB: signs of bone marrow suppression e.g. infection [particularly opportunistic organisms, such as cytomegalovirus] and unexplained bruising or bleeding, should be reported to the doctor or IBD nurse immediately.
Pregnancy must be excluded prior to treatment and conception avoided until 6 weeks after treatment has finished. Breast feeding is also contraindicated.
It is possible that side effects may occur during treatment. These may include some of the following:
Other side effects may occur, but less frequently, such as:
Although this list of possible side effects may seem quite alarming it does not mean that you will have all, or indeed any of them. The fact that your doctor has decided that this medication is required to help control your symptoms means that you have difficult disease that needs strong medication to bring it under control and therefore reduce the risks of complications and possibly avoid the need for surgery.
You should be reassured that you will be closely monitored whilst taking this treatment and that if side effects do arise that these will be dealt with accordingly.
Your compliance with the monitoring programme is essential in the safety of your treatment.
Natalizumab is a specific humanised monoclonal antibody, which inhibits a4-integrins.
These affect the migration of leucocytes from the circulation into the tissues to set up inflammatory reactions.
A multi-centre trial of its effectiveness in severe Crohn’s disease was performed. After 2 infusions, 71% of patients showed a response and 44% achieved clinical remission at 6 weeks. Inflammatory protein levels in the blood improved.
The long term effectiveness is as yet unknown and this remains an experimental treatment, which is not as yet generally available.
Normacol is made up of granules of gluten-free sterculia. It has the appearance of ‘bird seed.’
It is a bulk-forming laxative used to relieve constipation. It works by increasing the mass of stool which presses on the intestinal wall stimulating peristalsis, thus promoting a bowel motions.
It may take a few days before sufficient bulk has built up to cause a bowel movement. This is quite usual and you should continue with the treatment.
5-10 ml is taken twice daily following breakfast and the evening meal. The granules are swallowed whole with 1-2 large glasses of water. It can also be sprinkled on food or taken in yoghurt etc. to help it ‘slip’ down.
The dose can be adjusted once a regular soft stool has been achieved.
Insufficient fluid intake can occasionally lead to obstruction of the bowel. Fluid intake should usually be at least one and a half litres daily (and not limited to tea and coffee).
It should not be taken immediately before bedtime when fluid consumption is normally considerably reduced.
Normacol may cause:
Olsalazine consists of 2 molecules of 5-ASA linked by a chemical bond which is split in the lower colon by colonic bacteria.
It is used to treat and maintain remission in acute mild to moderate UC.
Olsalazine is presented in tablet form and is to be swallowed whole with plenty of water and with food. Watery diarrhoea is a common side effect but can be reduced if the dose is increased slowly. Once the symptoms have been controlled, you will be given a lower maintenance dose. Although you might feel better, it is important to continue taking the medication as instructed to prevent the symptoms from coming back.
You should not take this drug if you are allergic to aspirin. It is not recommended for use if you have poorly functioning kidneys.
It is safe to take olsalazine during pregnancy as it is better for both you and your baby to treat active disease vigorously and effectively. The lowest effective dose will always be used.
Olsalazine is generally well tolerated and side effects are not often reported as the 5-ASA molecule remains intact until it reaches the colon (99%). However, some effects which may occur could include:
It may also cause a worsening of the colitis in a very few sensitive people.
Side effects tend to be related to the dose and can be minimised by gradually building up the dose. If side effects continue, the drug should be stopped.
NB: If you have any unexplained bleeding, bruising, sore throat, fever or generally feel unwell whilst taking the medication, you should see your doctor for a blood test and further advice who may stop treatment.
Pentasa is a slow release tablet form of mesalazine containing ethylcellulose coated granules of 5-aminosalicylic acid which are broken down in the stomach releasing the granules throughout the small and large intestine. Unlike other drugs in the group, it is unaffected by changes in the gut flora, pH of the surroundings or transit time (speed in which a substance takes to pass through the intestines).
Pentasa is used for the treatment and maintenance of remission in UC and CD. Due to its early breakdown in the stomach, it is particularly useful in small bowel Crohn’s disease.
Pentasa is presented in the following forms:
The above medications will be prescribed according to the site and severity of the inflammation and may be used in combination.
Once symptoms have been controlled, you will be given a lower maintenance dose. Although you might feel better, you must continue taking the medication as instructed to prevent the symptoms from coming back.
You should not take Pentasa if you are allergic to aspirin. It is not recommended if the kidneys are not working properly.
Pentasa can be used safely during pregnancy. It is better for both you and your baby that active disease is treated vigorously and effectively. The lowest effective dose will always be used. Negligible amounts may also be detected in breast milk but it is safe to continue.
Because of its slow release form, Pentasa has had few reported side effects, the most common of these being:
It may also cause a worsening of the colitis in sensitive people. If side effects occur, the dose can be reduced and gradually built up to tolerance levels. If they continue, the drug should be stopped.
NB: If you have any unexplained bleeding, bruising, sore throat, fever or generally feel unwell taking the medication, you should see your doctor for a blood test and further advice stop who may stop treatment.
Predfoam is a steroid foam containing prednisolone in a 20mg metered dose.
It is used in the treatment of left-sided colitis and rectal inflammation (proctitis).
Whilst lying on your left side, the lubricated applicator (disposable) is inserted through the anus into the rectum and the foam is released in a metered dose.
It is applied 1 – 2 times daily for 2 weeks and continued for a further 2 weeks if effective. You should continue taking the medication, even if you feel better, until instructed otherwise by your doctor.
It can generally be used safely and effectively to treat all cases of left-sided disease, even in pregnancy. However, Predfoam should not be used if:
Side effects are relatively rare as the steroid drug acts locally on the site of inflammation and very little is absorbed into the body. However, it may cause similar effects to those of steroids taken by mouth, such as:
This is a steroid enema in the form of a liquid containing prednisolone 20 mg.
It is used in the treatment of ulcerative colitis and is usually given at night time. The enema is retained in the bowel acting directly on the inflamed tissue. It is used in the treatment of left-sided colitis or rectal inflammation.
For the best results, you should be on your left side in bed with the end of the bed propped up if possible to help you hold the enema in better. Lubricate and insert the applicator through the anus and up into the rectum. Squeeze the bag gently ensuring all the liquid is expelled. Ideally it is held in the bowel overnight and any residual liquid will be passed when going to the toilet in the morning. However, if this is not possible, you should try and hold the liquid in for at least one hour so that it can act with effect on the inflamed area.
You should not use this enema if you have a bowel infection.
Predsol can be used with caution during pregnancy if the doctor feels that the benefits outweigh any potential hazards.
Side effects are relatively rare as the steroid drug acts locally on the site of inflammation and very little is absorbed into the body. However, it may cause similar effects to those of steroids taken by mouth, such as:
Predsol suppositories – used in treatment of proctitis and anal complications of CD. The same precautions apply. The suppositories are to be inserted morning and evening after having the bowels opened. Length of treatment will be determined by the doctor but will usually be for approximately one month.
It is a chemical combination of a substance called sulphapyridine (a sulpha antibiotic) and 5-aminosalicylic acid (5-ASA, an aspirin-like compound) linked by a chemical bond which is split in the colon by colonic bacteria, releasing the active 5-ASA.
The sulfapyridine ensures the active ingredient of the drug (5-ASA) reaches the colon without being broken down in the small intestine.
It is used for the treatment and maintenance of remission in ulcerative colitis and CD affecting the large intestine.
Salazopyrin is presented in several forms:
The above medications will be prescribed according to the site and severity of the inflammation and may be used in combination.
Once symptoms have been controlled, you will be given a lower maintenance dose. Although you might feel better, you must continue taking the medication as instructed to prevent the symptoms from coming back.
You should not take this drug if you are allergic to sulphonamides or aspirin. A blood test should be taken every month for 5 months after starting treatment.
Salazopyrin has been known to cause certain side effects in some people. However, some of these tend to only occur when starting the treatment and should soon disappear once tolerance is established, e.g. nausea and headaches. They are usually dose related and it may help to start with a lower dose and build it up.
Most patients experiencing gastric problems with uncoated Salazopyrin improve when switched to the enteric coated version. Other reactions are due to hypersensitivity patients should contact their doctor immediately, e.g. vomiting, stomach pain, skin rashes.
(Unpleasant side effects tend to be associated with the sulfapyridine portion of the drug).
Other reported side effects include:
It rarely causes:
Long-term clinical use and experimental studies have shown no adverse effects during pregnancy and the developing foetus.
A small amount does pass into breast milk, but should not cause any harm to the baby.
Urine may become orange coloured.
Soft contact lenses may become stained.
In the USA it is known as Azulfidine.
It is recommended that folic acid supplements are taken.
NB: If you have any unexplained bleeding, bruising, sore throat, fever or generally feel unwell whilst taking the treatment, you should see your doctor for a blood test and further advice who may stop the treatment.