Crohns disease medications may keep you in remission for a long time.
But what if they don’t? What if you are not improving?

Crohns disease medications. Free advice about Crohns treatment plan and Crohns medications. You need to know this.

Crohns medications side effects and precautions need to be discussed with patients? Do you know all about your medications?

Crohns medications should keep you in remission. Do you have many side effects from them?

Crohns disease medications have five basic categories.

Like all drugs, Crohns medications have side effects, allergic reactions, overdosing problems and much more. You really need to know more about your meds!

The goal in Crohns treatment is to keep the patient in remission (stop the inflammation and prevent flare-ups). Flare-ups are the active stage of the disease with symptoms.

Crohns medications that a doctor prescribes to a patient follow a Crohns treatment protocol. If one Crohns medication doesn’t work, the doctor tries step two. If the next one fails, he or she will try the next line of medicine.

There are five basic categories of Crohns disease medications and I have tried most of them. I have dispensed all of them to Crohns paients and Ulcerative Colitis patients and got enough feedback to write a book. All Crohns disease medications concentrate on treating and taking care of the symptoms because there is still no cure for Crohns disease (CD).

Crohns Disease Medications Step-By-Step:

This is a general Crohns treatment stet-by-step that varies with each individual patient.

  1. The first step in this pyramid is trying aminosalicylates. The indication for aminosalicylates (sometimes called salicylates) is documented for treatment of Ulcerative colitis which is another type of IBD (inflammatory bowel disease). But the salicylates are commonly used in Crohns disease. So mesalamine can be Crohns disease medication and Ulcerative colitis medication.

    Aminosalicylates are given for mild to moderate symptoms. Examples of these would be mesalamine and sulfasalazine.

    Sulfasalazine is a Crohns disease medication that is losing its popularity after mesalamine brands took over. But there still patients taking these.

    The brands of mesalamine are Asacol, Canasa, Lialda, Pentasa and Rowasa.

    Mesalamine is the first-line aminosalicylate type medication that works locally in the intestines. It is effective in mild to moderate cases of Crohns disease. Most of the mesalamine brands are specially coated (meaning they have a special cover for the release of the medication in the intestines instead of the stomach). Originally, they needed to be given at very high daily doses. Now, this is changing with the introduction of new and improved dosage forms like Lialda.

    They all contain exactly the same active ingredient called mesalamine. But they are all different packaging, dosage forms, color, company and price.

    The brand of Asacol makes mesalamine in tablet forms.

    The brand of Pentasa makes it in capsules.

    The same brand that makes Asacol now makes the rectal suppositories called Canasa.

    Rowasa brand of mesalamine makes it in the enema form.

    Lialda has an advantage over the other Crohns disease medications containing mesalamine because of its once daily dosing.

  2. The next step in Crohns disease medications protocol would probabaly be adding an antibiotic like ciprofloxacin and/or metronidazole if aminosalycilates are not helping. The reason is still unknown as to why exactly antibiotics are working in this case. Antibiotics kill bacteria. Crohns disease is not proven to be caused by bacteria but was questioned if Mycobacteria was a possible cause. But antibiotics are used to treat fistulas. Fistulas are like abnormal growths or tunnels between two parts or two organs of the body. Unfortunately, fistulas come back in half of the cases when antibiotics are stopped.

    Cipro (ciprofloxacin) is a Crohns disease medication that is usually given for at least one month or more. This may cause disbacteriosis (bacterial overgrowth) so you would need to get a great probiotic to replenish the good bacteria in the gut. Make sure to space the probiotic with an antibiotic by at least two hours before and after ciprofloxacin.

    Flagyl is the brand of metronidazole. It's an antibiotic Crohns medication. This Crohns disease medication is prescribed if the patient is allergic to ciprofloxacin or for other possible reasons. You cannot take any alcohol while on metronidazole. You can not even use alcohol based mouth rinses when taking metronidazole.

  3. The next step in the Crohns treatment protocol is usually Corticosteroids like Prednisone. They are usually given for a shorter duration of time than other Crohns disease medications because they have very serious side effects.

    Oral Prednisone comes in tablet form and it causes many mood disorders, even behavioral disturbances. Prednisone is one of the most potent Crohns disease medications. But has many, many side effects.

    There’s a different type of a corticosteroid used for Crohns disease called Entocort EC(generic name is budesonide). It causes less side effects due to its dosage form but doesn’t work as well as prednisone. The indication for Entocort EC includes treatment of active (mild to moderate) Crohns disease.

    The corticosteroids will reduce the inflammation but the doctor would probably recommend Calcium with vitamin D supplementation because of the risk of developing osteoporosis.

  4. The next step would be to add Crohns medications that suppress the immune system. These are called immunomodulators like Azathioprine, 6MP or methotrexate. These kind of medications would be added to an aminosalicylate and corticosteroid because they take a long time to work. After about three months of therapy with the immunomodulators the corticosteroid is tapered and eventually discontinued.

    Azathioprine and methotrexate are Crohns medications that have been around longer but are prescribed less from this class of medications at the present time.

    You would rarely see a prescription for it but Azathioprine is still prescribed and it comes in tablet form.

    Methotrexate is a Crohns medication that is mostly used for Crohns arthritis.

    6MP (mercaptopurine) is probably the most commonly prescribed Crohns disease medication from this class for Crohns disease patients. Remember to have your doctor monitor blood levels at least once a month. Mercaptopurine has serious side effects like decreased immune system response which can make you more prone to getting infections.

  5. After the steroids are eventually discontinued and the symptoms are fully under control your doctor may give you an option of adding tumor necrosis factor(TNF) antagonist like Remicade (infliximab) or Humira (adalimumab) to your Crohns disease medication list. These are used to treat fistulas when antibiotics can’t do the job. Humira is usually offered when patients have an allergic reaction to Remicade or other TNF blockers or if Remicade would stop working. These Crohns medications are also referred to as biologicals and have many potential side effects.

    When the doctor administers a TNF blocker through the IV in his/her office you would be given a dose of Benadryl (diphenhydramine) to prevent a possible allergic reaction (it doesn’t guarantee to prevent it completely). You would also receive a dose of a pain reliever/fever reducer like Tylenol.

    Remicade is approved for Crohns disease and is also given to rheumatoid arthritis patients. This Crohns medication usually works fast but also can make you more prone to infections.

    Humira is becoming more and more popular and it has an approved indication for treatment of moderate to severe Crohns disease.

    There are newer kinds of TNF blockers on the market called Tysabri (natalizumab) and Cimzia ( certolizumab pega). They both are indicated for moderate to severe Crohns cases.

    Cimzia may have an advantage because it is injected under skin instead of through IV. To learn more about it, click Cimzia.

    All these biologicals are very expensive and some insurance companies are not willing to pay for these yet. The pharmaceutical industry is working hard on making a new type of biological that would be easier to administer, would cost less and have less side effects. I am personally hoping they find a cure soon!

When and if the symptoms are too severe to treat with Crohns medications your doctor may refer you to the hospital where you would be given an intravenous (IV) corticosteroid like hydrocortisone. Enteral nutrition may be started through a gastric tube or nasogastric tube when the patient is unable to take anything by mouth.

The last resort is a Crohns surgery which has potential for many other problems. During surgery the affected part of the intestine would be removed leaving as much of healthy intestine as possible. The surgery does not guarantee a positive outcome.

When symptoms improve the doctor may try reducing the Crohns disease medications. The idea here is to “go slow”. The steroids, immunomodulators, biologicals and antibiotics may eventually be discontinued but, most likely your doctor would want you to stay on aminosalicylate to reduce the risk of colon cancer due to chronic inflammation.

Whether you are going to stay on aminosalicylate (5-ASA) forever is entirely up to you and your doctor. Some doctors would probably allow you a trial without any Crohns disease medications but only after you improve tremendously. Some doctors that incorporate a holistic approach to medicine may recommend you to continue with some herbs and acupuncture.

5 Great Tips When Taking Crohns Disease Medications:

  • Read current Crohns disease information.
  • Find an expert-gastroenterologist that also makes you comfortable.
  • Drink plenty of water.
  • Report unusual symptoms immediately if taking Crohns medications.
  • Stress relief techniques should always be a part of any Crohns disease patient’s life!

I wish you well!

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