The goal of medicinal treatment is to 1) suppress the inflammatory response, 2) reduce symptoms of Crohn’s disease, and 3) induce and maintain longer periods of remission.
These groups of drugs are used to treat Cohn’s disease:
These types of medicines are often the first line of treatment for people with Crohn’s disease. They help relieve diarrhea and abdominal pain. Many anti-diarrheal medicines are available over the counter (such as Imodium A.D.), but some doctors will prescribe stronger doses if they’re needed. Anti-diarrheal medicines include:
These medicines decrease inflammation in the intestines. Examples of anti-inflammatory medicines include:
This group of anti-inflammatory drugs is used to treat mild to moderate cases of Crohn’s disease. They may be taken orally or rectally and work directly on inflamed tissue. Aminosalicylates include:
- canasa suppository
- mesalamine (Asacol, Colazal, Dipentum, Pentasa)
- rowasa enema
- sulfasalazine (Azulfidine)
This potent group of anti-inflammatories can be taken orally or rectally and is highly effective. They work to suppress the immune system and reduce the activity of the disease in people with moderate to severe Crohn’s disease. (Corticosteroids are also sometimes given intravenously in the hospital.)
Because this type of medication suppresses the entire immune system (not just targeted portions) and can cause severe side effects—such as high blood pressure, insomnia, and weight gain—doctors limit the amount of time patients have to take corticosteroids as much as possible. Systemic corticosteroids include:
Unlike traditional corticosteroids, topical corticosteroids work directly on inflamed tissue, not the immune system as a whole. Therefore, they have fewer side effects than traditional corticosteroids. Topical corticosteroids include:
- budesonide (Entocort EC)
While it’s not entirely understood how they work, antibiotics have been shown to decrease the body’s immune and inflammation response. Antibiotics also treat fistulae. Antibiotics commonly prescribed to patients with Crohn’s disease include:
- ciprofloxacin (Cipro)
- metronidazole (Flagyl)
Sometimes called immunomodulators or immune system suppressors, these drugs reduce tissue inflammation by decreasing the amount of immune cells and slowing their production. They also help heal fistulae and maintain disease remission. When used with corticosteroids, patients are often able to take lower doses of corticosteroids, which decreases the risk of side effects. Commonly prescribed immune modifiers include:
- 6-mercaptopurine (6-MP)
- Adalimumab (Humira) also blocks the production of TNF-alpha, which reduces inflammation and relieves other symptoms.
- Azathioprine (Imuran) and mercaptopurine (Purinethol) are the most commonly-prescribed immune system suppressors. It can take several months for these medicines to work, but they can help reduce signs and symptoms of Crohn’s disease and heal fistulas.
- Certolizumab pegol (Cimzia) is another anti-TNF-alpha drug that may be used in women of child-bearing age because it does not cross the placenta.
- Cyclosporine (Gengraf, Neoral, Sandimmune) can treat Crohn’s-related fistulas, but because of potential side effects—such as liver damage, seizures, and fatal infections—doctors reserve it for use in people who don’t respond well to other medications.
- Infliximab (Remicade) has been approved to help diminish enterocutaneous fistulae. It works by blocking the body’s production of tumor necrosis factor-alpha (TNF-alpha), a protein which research suggests may be linked to inflammation.
- Methotrexate (Rheumatrex, Trexall) is primarily used to treat cancer, rheumatoid arthritis, and psoriasis. Crohn’s disease researchers and doctors have used it in patients who do not respond to other types of medicine.
- Natalizumab (Tysabri) helps induce and maintain periods of remission and inactivity by blocking white blood cells that cause inflammation.