Crohn's Disease: Medications

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Medications

Medicines usually are the treatment of choice for Crohn's disease. They can control or prevent inflammation in the intestines and help:

• Relieve symptoms.
• Promote healing of damaged tissues.
• Put the disease into remission and keep it from flaring up again.
• Postpone the need for surgery.

Medication Choices

The choice of medicine usually depends on the severity of the disease, the part of the intestines that is affected, and whether complications are present.

• Treatment of mild to moderate Crohn's disease often begins with aminosalicylates (such as sulfasalazine or mesalamine), which help prevent inflammation.
• Antibiotics (ciprofloxacin or metronidazole) will probably be tried if aminosalicylates don't help your symptoms. Antibiotics are also useful for some complications of Crohn's disease and are used to treat fistulas.
• Corticosteroids may be added if symptoms continue. Corticosteroids usually stop symptoms and put the disease in remission. But they are not used as long-term treatment to keep symptoms from coming back.
• Stronger treatment with medicines that suppress the immune system (such as azathioprine [AZA], 6-mercaptopurine [6-MP], and methotrexate), cyclosporine, and intravenous (IV) corticosteroids may be needed for severe cases.
• Additional medicines, such as tumor necrosis factor (TNF) antagonists, may be used for people who develop abnormal connections between the intestines and other organs (fistulas) or who have severe Crohn's disease that does not respond to other medicines. These medicines can be used to keep symptoms from coming back.

Other medicines that suppress the immune system are being studied for Crohn's disease. These include CDP870, interleukins 10, 11, and 12, tacrolimus, mycophenolate mofetil, natalizumab, and thalidomide. Natalizumab (Tysabri), which is approved for treating multiple sclerosis, has been shown to have some benefit in treating Crohn's disease.² Natalizumab is very tightly controlled because of the risk of developing progressive multifocal leukoencephalopathy, a neurological disease.

What To Think About

Most of these medicines also can be used in children. Infliximab is approved by the U.S. Food and Drug Administration (FDA) for use in children.

If you are pregnant, talk to your doctor about which medicines might be okay to take for Crohn's disease. Sometimes, severe Crohn's disease can harm your baby more than the medicines you are taking to keep it under control. Some medicines, though, should never be taken when you are pregnant. Your doctor can tell you which medicines are okay for you while you are pregnant and nursing.

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Last updated:	October 24, 2006
Author:	Monica Rhodes
Reviewed By:	Kathleen Romito, MD - Family Medicine, Arvydas D. Vanagunas, MD - Gastroenterology
Editors:	Kathleen M. Ariss, MS, Terrina Vail