Details on IBD Medicines

[GNC Crohn's Man]

http://www.ccfa.org/info/treatment/medications

Types of Medications

At the present time, there are five basic categories of medications used in the treatment of IBD. They are:

* Aminosalicylates
* Corticosteroids
* Immunomodulators
* Antibiotics
* Biologic therapies

Medical treatment for Crohn's disease and ulcerative colitis has two main goals: achieving remission (the absence of symptoms) and, once that is accomplished, maintaining remission (prevention of flare-ups). To accomplish these goals, treatment is aimed at controlling the ongoing inflammation in the intestine—the cause of IBD symptoms.

There is no standard regimen for managing all people with IBD. The symptoms, course of disease, and prognosis vary considerably. Proper disease treatment depends upon an accurate diagnosis. This typically requires endoscopic (the use of lighted tubes to view the intestine), radiologic (X-rays), and pathologic (analysis of tissues) examinations. A successful treatment strategy employs not only medical therapy, but careful attention to detail and judicious use of common sense.

Despite advances in medical therapies, some people with IBD eventually will require surgery—either to control their disease or to address various complications. Surgical intervention is integral to the care of people with IBD, and surgical consultants experienced in IBD are vital to proper treatment. Knowing when surgery is indicated and how to operate on these diseases is of paramount importance to both immediate and long-term outcomes. For detailed information about the role of surgery in IBD, consult the appropriate section of this Web site.

As active partners in the treatment of your illness, you and your doctor should discuss, in detail, all of the medical and surgical options available to you. Reading material such as this will help you stay informed about the latest therapies and surgical techniques, and give you tips about coping with your illness from day to day. Remember, hundreds of thousands of people with IBD are living productive, fulfilling lives. With proper care, you can, too.

 

[GNC Crohn's Man]

http://www.ccfa.org/info/treatment/aminosalicylates

Aminosalicylates
Aminosalicylates are compounds that contain 5-aminosalicylic acid (5-ASA). These drugs, which can be given either orally or rectally, interfere with the body's ability to control inflammation. They are effective in treating mild-to-moderate episodes of ulcerative colitis and Crohn's disease, as well as preventing relapses and maintaining remission.

Oral Medications
Sulfasalazine (Azulfidine®), the first aminosalicylate to be widely used for IBD, is effective in achieving and maintaining remission in people with mild-to-moderate disease. The active portion of the drug, 5-ASA, is bonded to sulfapyridine, a compound that delivers 5-ASA to the intestine but comes with disagreeable side effects in some patients, such as headache, nausea, and rash. However, sulfasalazine is inexpensive and effective for the many patients who can tolerate it.

Researchers have also developed newer oral drugs that deliver 5-ASA without sulfapyridine. These include:

* mesalamine (Asacol®, Pentasa®, Apriso™, Lialda® );
* olsalazine (Dipentum®); and
* balsalazide (Colazal™).

Up to 90 percent of people who cannot tolerate sulfasalazine are able to take other 5-ASAs.

Alternative Methods of Delivery
In addition to conventional oral preparations, there are several other ways to deliver 5-ASA to the bowel. Patients with Crohn's disease or ulcerative colitis may have bowel inflammation in different locations, which is why the various 5-ASAs have been designed to be released in different areas of the bowel:

* Local mesalamine preparations are effective precisely because they bypass the stomach to avoid early digestion, and then release close to the inflamed section of the bowel. There, the medication coats the inflamed bowel lining, thus decreasing the inflammation.

* Enema formulations (Rowasa®) allow mesalamine to be applied directly to the left colon. Rowasa is effective in mild-to-moderate colitis that affects only the left side of the colon. Up to 80 percent of patients with left-sided disease benefit from using this therapy once a day.

* Suppositories (Canasa®) deliver mesalamine directly from the rectum up to the sigmoid colon (the lower part of the large intestine). A high proportion of patients with ulcerative proctitis—ulcerative colitis that is limited to the rectum and the lower end of the colon—will respond to mesalamine suppositories. These are usually given in single or twice-daily doses. A combination of mesalamine enemas and pills may be more effective than pills alone.

* Oral, delayed-release (Pentasa®) and extended-release (Apriso™) preparationscan release 5-ASA directly to the small intestine and colon, or to the ileum (the lower part of the small intestine) and/or the colon (Asacol® and Lialda®), or to the colon only (Dipentum®, Colazal™, Sulfasalazine®).

Side Effects

* Sulfasalazine: Side effects may include headache, nausea, loss of appetite, vomiting, rash, fever, and decreased white blood cell count. Sulfasalazine can also decrease sperm production and function in men while they are taking the medication (sperm count becomes normal after the medication is discontinued). It has been rarely associated with inflammation of the pancreas (pancreatitis).

* Mesalamine: Side effects may include abdominal pain and cramps, diarrhea, gas, nausea, hair loss, headache, and dizziness. People with kidney disease should use caution when taking mesalamine, as some studies have found that the medication may be linked to kidney problems. Patients on long-term mesalamine therapy may be monitored regularly for any signs of decreased kidney function. Pancreatitis is a rare side effect of mesalamine use.

* Olsalazine: Diarrhea is the most common side effect. It can be reduced by taking the medication with food. Less common side effects may include headache, rash, and fatigue. Even rarer are hair loss, pancreatitis, or inflammation of the tissue surrounding the heart (pericarditis).

* Balsalazide: The most common side effects are headaches and abdominal pain. Less common are nausea, diarrhea, and vomiting.


Note: Similar rates of most of the side effects listed above have been seen in patients who received placebo (sugar pills) instead of balsalazide in clinical trials.

Drug Interactions
People taking several different medicines, whether prescription or over-the-counter, should always be on the lookout for interactions between drugs. Drug interactions may decrease a medication's effectiveness, intensify the action of a drug, or cause unexpected side effects. Before taking any medication, read the label carefully. Be sure to tell your doctor about all the drugs you're taking (even over-the-counter medications or complementary therapies) and any medical condition you may have. However, there are very few important drug interactions with these medications, with the exception of sulfasalazine.

Special Considerations

* Sulfasalazine cannot be used by people who are allergic to or cannot tolerate sulfa drugs (approximately one-third of people being treated). Other sulfa-containing drugs should be used with caution while taking sulfasalazine.

* Not only is every patient different, but a patient's therapeutic needs may change over time. Be sure to communicate regularly with your doctor, and stay informed about all of the medical and surgical options available to you.

* Patients who stop their 5ASAs are likely to suffer a relapse. Only stop your medication with the approval of your doctor.

* 5-ASAs are generally safe during pregnancy and nursing.

* Because IBD is a chronic condition, it is advisable to stay on your medications even when you are feeling well.


Date Updated: September 9, 2009

 

[GNC Crohn's Man]

http://www.ccfa.org/info/treatment/corticosteroids

Corticosteroids
Corticosteroids (often referred to simply as steroids but are not to be confused with body-building "steroids") were first introduced as therapy for IBD in the 1950s. Since that time, these powerful and fast-acting anti-inflammatory drugs have been the mainstay of treatment for acute flare-ups of disease. Most patients notice an improvement in symptoms within days of starting corticosteroids. In addition to their anti-inflammatory action, corticosteroids also are immunosuppressive. That means they decrease the activity of the immune system, which experts believe may be out of control in people with IBD. As a result, they may make certain individuals more susceptible to catching infections.

Corticosteroids closely resemble cortisol, a hormone naturally produced by the body's adrenal glands. This group of medications is available in oral, rectal, and intravenous (IV) forms. When people take corticosteroids, their adrenal glands stop producing or slow down the production of normal cortisol.

In general, corticosteroids are recommended only for short-term use in order to achieve remission. As valuable as they are in acute situations, corticosteroids are not effective in preventing flare-ups and therefore are rarely used for maintenance therapy in IBD. In addition, long-term use is not advised because of undesirable side effects. For that reason, corticosteroids are usually given in the lowest possible dosage for the shortest amount of time. Frequent short-duration use, however, is not recommended.

Oral Medications
In people with moderate to severe active disease, corticosteroids in pill form are usually effective. These include:

* prednisone (Deltasone®)
* methylprednisolone (Medrol®)
* hydrocortisone

The drugs may be used alone or together with aminosalicylate (5-ASA) drugs to reduce acute inflammation.

Budesonide
One of the latest oral corticosteroids is budesonide (Entocort® EC), used to treat mild-to-moderate Crohn's disease involving the end of the small intestine (the ileum) and/or the first part of the large intestine (the cecum and ascending colon). Representing a new class of corticosteroids called nonsystemic steroids, it targets the intestine rather than the whole body. Because 90% of the drug is inactivated before it reaches the rest of the body, it causes fewer side effects than traditional corticosteroids such as prednisone. Side effects include headache, respiratory infection, and nausea, among other corticosteroid-associated side effects.

Alternative Methods of Delivery
For people who do not respond to oral forms of the drugs, it may be necessary to administer corticosteroids through other routes. These include:

* Rectally as enemas (hydrocortisone, methylpredisone, Cortenema®), foams (hydrocortisone acetate, ProctoFoam-HC®), and suppositories. These preparations are helpful for patients with mild-to-moderate ulcerative colitis that is limited to the rectum or lower part of the colon. They also may be used, together with other therapies, in people with mild-to-moderate disease near the rectum or with more widespread disease that starts at the rectum.

* Intravenously (IV): methylpredisone and hydrocortisone. Patients with severe and extensive disease may require treatment with IV corticosteroids.

Side Effects
The undesirable side effects of corticosteroids are dependent on both dose and duration of treatment. For many, the side effects of steroids outweigh their anti-inflammatory benefits. Some of the most common ones include the following:

* high blood pressure (hypertension)
* rounding of the face ("moon face")
* increased risk of infection
* weight gain
* acne
* mood swings
* psychosis and other psychiatric symptoms
* increased facial hair
* cataracts
* stretch marks
* high blood sugar levels
* weakened bones (osteoporosis)
* insomnia (difficulty sleeping)

Because of these side effects, doctors frequently choose safer medications, such as the 5-ASA drugs and antibiotics, as initial therapy. But there are a number of ways to reduce the risk of developing side effects. These include rapid but careful tapering off of steroids; alternate-day dosing; rectally applied corticosteroids; and rapidly metabolized corticosteroids such as budesonide (described above). To help prevent osteoporosis, many doctors routinely prescribe calcium supplements as well as multivitamins that contain vitamin D. Another option is the use of bisphosphonates, such as risedronate (Actonel®) and alendronate (Fosamax®). These compounds, which have been shown to help avert bone loss, are effective in treating and preventing steroid-induced osteoporosis.

Drug Interactions
People taking several different medicines, whether prescription or over-the-counter, should always be on the lookout for interactions between drugs. Drug interactions may decrease a medication's effectiveness, intensify the action of a drug, or cause unexpected side effects. Before taking any medication, read the label carefully. Be sure to tell your doctor about all the drugs you're taking (even over-the-counter medications or complementary therapies) and any other medical condition you may have.

Special Considerations

* Because corticosteroids cause the adrenal glands to slow or stop the production of cortisol, they cannot be discontinued abruptly. It takes some time for the adrenal glands to begin producing cortisol again. Gradually tapering the dose of corticosteroids allows the body to begin producing its own supply of cortisol again.

* Twenty to 30 percent of patients with acute symptoms of IBD will not respond to corticosteroids.

* Thirty to 40 percent of patients with moderate-to-severe IBD have steroid-dependent disease. That means that they are unable to taper off steroids without experiencing a flare-up.

* Corticosteroids are one of the oldest treatments available for IBD, but many newer drugs are now available. Be sure to talk to your doctor to learn all you can if you are prescribed steroids, and review what other options may be available to you once your symptoms are brought under control.
.

Date Posted: January 16, 2009

 

[GNC Crohn's Man]

http://www.ccfa.org/info/treatment/immunomodulators

Immunomodulators
As their name implies, immunomodulators weaken or modulate the activity of the immune system. That, in turn, decreases the inflammatory response. Immunomodulators are most often used in organ transplantation to prevent rejection of the new organ, and in autoimmune diseases such as rheumatoid arthritis. Since the late 1960s, they have also been used to treat people with IBD, which appears to be caused by an overactive immune system. These drugs are appropriate for those who:

* do not respond to aminosalicylates, antibiotics, or corticosteroids
* have steroid-dependent disease or frequently require steroids
* have experienced side effects with corticosteroid treatment
* have perineal disease that does not respond to antibiotics
* have fistulas (abnormal channels between two loops of intestine, or between the intestine and another structure—such as the skin)
* need to maintain remission

An immunomodulator may be combined with a corticosteroid to speed up response during active flares of disease. Lower doses of the steroid are required in this case, producing fewer side effects. Corticosteroids also may be withdrawn more rapidly when combined with immunomodulators. For that reason, immunomodulators are sometimes referred to as "steroid-sparing" drugs.

Oral Medications
The first two immunomodulators to be used widely in IBD are azathioprine (Imuran®, Azasan®) and 6-mercaptopurine (6-MP, Purinethol®), drugs that are chemically quite similar. They are used to maintain remission in Crohn's disease and ulcerative colitis. Both have a slow onset of action (three to six months for full effect). Accordingly, they are usually given along with another faster-acting drug (such as corticosteroids).

Other immunomodulators to treat IBD are cyclosporine A (Sandimmune®, Neoral®) and tacrolimus (Prograf®), both used for organ transplantation as well. Cyclosporine A has a more rapid onset of action (one to two weeks) than azathioprine and 6-MP. It is useful in people with active Crohn's disease, but only when given intravenously and at high doses. Both cyclosporine A and tacrolimus have been more effective in treating people with severe ulcerative colitis, and are generally given until one of the slower-acting immunomodulators begins to work or until the patient undergoes curative surgery. Tacrolimus can be used in Crohn's disease when corticosteroids are not effective or when fistulas develop.

Alternate Methods of Delivery
Tacrolimus may be applied topically for Crohn's disease that affects the mouth or perineal area. Topical tacrolimus is also used to treat pyoderma gangrenosum, an ulcerating skin disorder often associated with IBD.

Methotrexate (MTX®, Rheumatrex®, Mexate®) works more rapidly than azathioprine or 6-MP, and is given by weekly injections. It is an effective option for people with Crohn's disease who have not responded to other treatments and cannot tolerate other immunosuppressants. The effectiveness of methotrexate in ulcerative colitis is as yet unproven.

Side Effects

* Azathioprine and 6-MP: Infrequently reported side effects may include headache, nausea, vomiting, diarrhea, and malaise (general feeling of illness). Sometimes changing from azathioprine to 6-MP or vice versa may reduce some of these reactions. Canker sores in the mouth, rash, fever, joint pain, and liver inflammation are unlikely to be affected by changing from azathioprine to 6-MP or vice versa. Less common side effects include pancreatitis (inflammation of the pancreas) and bone marrow suppression, which may increase the risk of infection or serious bleeding. A return to normal blood cell production may take several weeks after discontinuing the medication.

* Cyclosporine and tacrolimus: Infrequently reported side effects include decreased kidney function, hepatitis, increased risk of infections, diabetes, increased cholesterol levels, sleep problems, headache, mild tremor, high blood pressure, swollen gums, tingling of the fingers and feet, increased facial hair, and increased risk of lymphoma (a cancer of the lymphatic system).

* Methotrexate: Infrequently reported side effects include flu-like symptoms (nausea, vomiting, headache, fatigue, and diarrhea) and low white blood cell count. Less common but more serious side effects include scarring of the liver and lung inflammation. Scarring of the liver can be made worse by diabetes, being overweight, and alcohol consumption.

Drug Interactions
People taking several different medicines, whether prescription or over-the-counter, should always be on the lookout for interactions between drugs. Drug interactions may decrease a medication's effectiveness, intensify the action of a drug, or cause unexpected side effects. Before taking any medication, read the label carefully. Be sure to tell your doctor about all the drugs you're taking (even over-the-counter medications or complementary therapies) and any medical condition you may have.

Special Considerations

* Immunomodulators reduce the activity of the immune system. In so doing, they also decrease the body's ability to combat infection. Be sure to report any incidence of fever, chills, or sore throat to your doctor.

* Blood tests should be performed frequently with all immunomodulators to check for effects on the bone marrow, liver, and kidneys. Blood pressure and kidney function need to be closely monitored with cyclosporine A and tacrolimus.

* Women who are pregnant or wish to become pregnant should talk to their doctors before taking immunomodulators. Methotrexate use should be avoided (by pregnant women and by both men and women for several months before conception) because it may lead to pregnancy loss or possible birth defects.


Date Posted: January 16, 2009

 

[GNC Crohn's Man]

http://www.ccfa.org/info/treatment/antibiotics

Antibiotics
Antibiotics are frequently used as a primary treatment approach in IBD, even though no specific infectious agent has been identified as the cause of these illnesses. However, researchers believe that antibiotics can help control symptoms of IBD by reducing intestinal bacteria and by directly suppressing the intestine's immune system.

Antibiotics are effective as long-term therapy in some people with IBD, particularly Crohn's disease patients who have fistulas (abnormal channels between two loops of intestine, or between the intestine and another structure—such as the skin) or recurrent abscesses (pockets of pus) near their anus. Patients whose active disease is successfully treated with antibiotics may be kept on these as maintenance therapy as long as the medications remain effective.

Although helpful in people with Crohn's disease, antibiotics generally are not considered useful for those with ulcerative colitis, either for maintaining remission or in acute situations. Clinical trials have not shown that antibiotics have value in treating severe ulcerative colitis. The exception is toxic megacolon, a condition that places people at high risk for perforation. This life-threatening complication is characterized by a distended abdomen and an extremely inflated colon.

Oral Medications
Although there are several antibiotics that may be effective for certain people, the two most commonly prescribed in IBD are:

• Metronidazole (Flagyl®)
• Ciprofloxacin (Cipro®)

Both metronidazole and ciprofloxacin are broad-spectrum antibiotics that by definition fight a wide range of bacteria. Metronidazole is the most extensively studied antibiotic in IBD. As a primary therapy for active Crohn's, this drug has been shown to be superior to placebo (sugar pill) and equal to sulfasalazine—especially when the illness affects the colon.

Metronidazole also has been shown to reduce the recurrence of Crohn's for the first three months after ileum resection surgery. In more than 50 percent of those treated, metronidazole can be effective in managing perineal Crohn's (disease involving the pelvic area). Metronidazole also is used to suppress an overgrowth of C. difficile, a type of bacteria that causes inflammation.

Another indication for metronidazole is in people who develop "pouchitis" after ileal-pouch anal anastomosis surgery. In this procedure, after the colon is removed, an internal pouch is formed from the patient's ileum (the lowest part of the small intestine)—averting the need for an external appliance. Sometimes the pouch becomes severely inflamed; hence the term "pouchitis."

Ciprofloxacin is commonly used to treat active Crohn's disease and pouchitis. It is also far safer than metronidazole.

Alternative Methods of Delivery
Both metronidazole and ciprofloxacin are available in intravenous (IV) forms and may be used as such when needed.

Side Effects
Metronidazole: Common side effects may include nausea, vomiting, loss of appetite, a metallic taste, diarrhea, dizziness, headaches, and discolored urine (dark or reddish brown). Another side effect of long-term use is tingling of the hands and feet, which may persist even after the drug is discontinued. If you develop such tingling, notify your doctor immediately. The medication should be stopped and not restarted.

Ciprofloxacin: Side effects may include headaches, nausea, vomiting, diarrhea, abdominal pain, rash, and restlessness, all of which are rare.

Drug Interactions
People taking several different medicines, whether prescription or over-the-counter, should always be on the lookout for interactions between drugs. Drug interactions may decrease a medication's effectiveness, intensify the action of a drug, or cause unexpected side effects. Before taking any medication, read the label carefully. Be sure to tell your doctor about all the drugs you're taking (even over-the-counter medications or complementary therapies) and any medical condition you may have.

Special Considerations

* Metronidazole affects the breakdown of alcohol, which may result in nausea and vomiting. Therefore, avoid alcohol in any form while on this medication and until at least two days following the last dose.

* Ciprofloxacin can interact with antacids (such as Rolaids and Tums), so do not take both within the same few hours. It also interacts similarly with vitamin and mineral supplements that contain calcium, iron, or zinc. Taking antacids or these vitamins and minerals too close to a dose of ciprofloxacin can greatly reduce the effects of the antibiotic.

* Let your doctor know if you are pregnant before taking metronidazole or ciprofloxacin. They are often prescribed during pregnancy, but make sure to discuss these medications with your doctor first.

* Avoid exposure to the sun while on these antibiotics. When you go outside, wear sunscreen during daylight hours—and avoid tanning booths.

* Antibiotics can decrease the effectiveness of oral contraceptive medications (birth control pills).

* Antibiotics can dangerously interfere with the anticoagulant medication warfarin (Coumadin®), making the blood too thin and increasing the risk of bleeding. Adjustments in the dose of warfarin may be required if antibiotics are started. Be sure to inform any physician prescribing antibiotics for you if you are taking warfarin.


Updated 8/28/08

 

[GNC Crohn's Man]

http://www.ccfa.org/info/treatment/biologics

Biologic Therapies
The newest class of drugs to be used in IBD, these include Adalimumab (Humira®), Certolizumab pegol (Cimzia®), Infliximab (Remicade®), and Natalizumab (Tysabri®). Biologics are genetically engineered medications made from living organisms and their products, such as proteins, genes, and antibodies. Biologics interfere with the body's inflammatory response in IBD by targeting specific molecular players in the process such as cytokines—specialized proteins that play a role in increasing or decreasing inflammation. Promising targets include tumor necrosis factor (TNF)-alpha, interleukins, adhesion molecules, colony-stimulating factors, and others. Learning how these factors work has enabled researchers to design special treatment approaches that interrupt inflammation at various stages.

Biologic therapies offer a distinct advantage in IBD treatment. Their mechanism of action is targeted. Unlike corticosteroids, which tend to suppress the entire immune system and thereby produce major side effects, biologic agents act selectively. Therapies are targeted to particular enzymes and proteins that have already been proven defective, deficient, or excessive in people with IBD and in animal models of colitis.

Anti-TNF

Within the last decade, a class of biologics known as anti-TNF was introduced for use in Crohn's disease. More recently, anti-TNF has been used in ulcerative colitis. These therapies suppress part of the immune system by binding to and inactivating tumor necrosis factor alpha (TNF-alpha). TNF-alpha is a cytokine, a specialized protein that promotes inflammation in the intestine in other organs and tissues.

Infliximab (Remicade®) is the first FDA-approved biologic therapy for Crohn's disease and fistulizing Crohn's disease, as well as for ulcerative colitis. It is given as a drip via intravenous infusion. The medication is a chimeric monoclonal antibody. In other words, it's a hybrid consisting of 75 percent human, 25 percent mouse protein sequence. It is used for people with moderately-to-severely active disease who have not responded well to other therapies.

Adalimumab (Humira®) was approved for use in Crohn's disease. It also binds to and inactivates tumor necrosis factor alpha, but it is a fully human monoclonal antibody. It is given by injection. It is used for people with moderately to severely active disease who have not responded well to other therapies, and who have lost response or are unable to tolerate infliximab.

Certolizumab pegol (Cimzia®) was recently approved for use in Crohn's disease. It the first and only PEGylated anti-TNF-alpha. The antibody portion combines with a special chemical called polyethelyene glycol (PEG), which delays its excretion from the body. It is given by injection. It is used to reduce the signs and symptoms of moderately to severely active Crohn's disease in adult patients who have not been helped enough by usual treatments.

Integrin Receptor Antagonist

A recent development in biologic therapy is the development of integrin receptor antagonists. Their mechanism of action is different from the anti-TNF agents. Integrin receptor antagonists work by binding to particular cells in the bloodstream that are key players in inflammation.

Natalizumab (Tysabri®) was recently approved for use in Crohn's disease. It is a recombinant humanized monoclonal antibody thought to inhibit certain types of white blood cells that are involved in the inflammatory process. It is given by IV infusion for moderate to severely active Crohn's patients who have had an inadequate response to, or are unable to tolerate, conventional and anti-TNF disease therapies.

In the Pipeline

In addition, there is a "pipeline" of drugs that are in the very early stages of development. These include many more biologics with different modes of action. They are structured to interrupt the out-of-control signalling within different pathways in an immune system that simply won't shut off. By uncovering additional mechanisms, investigators expect to generate increased options for the treatment of chronic inflammatory diseases. Additional biologic therapies under investigation for IBD include alicaforsen for ulcerative colitis; thalidomide; the interleukins IL-6, IL-10, IL-11, and IL-12; interferon gamma, and GM-CSF.

Side Effects

The most common side effects with the anti-TNF agents include infusion or injection site reactions (redness, swelling, itching, bruising, rash), upper respiratory infections, headaches, rash, and nausea. Check with your doctor about other possible side effects.

Drug Interactions
People taking several different medicines, whether prescription or over-the-counter, should always be on the lookout for interactions between drugs. Drug interactions may decrease a medication's effectiveness, intensify the action of a drug, or cause unexpected side effects. Before taking any medication, read the label carefully. Be sure to tell your doctor about all the drugs you're taking—even over-the-counter medications or complementary therapies—and any medical conditions you may have.

Special Considerations

* There have been some reports of serious infections associated with anti-TNF agent use, including tuberculosis (TB) and sepsis, a life-threatening blood infection. You should always have a TB skin test before you use infliximab, adalimumab, or certolizumab because these therapies can increase the risk of active TB for those who have been exposed. It's not that you will "catch" TB when taking infliximab, adalimumab, or certolizumab but if you have latent (inactive) TB, the drug can reactivate the infection. In this case, your doctor should begin TB treatment before you start these medications. The same precaution should be taken before beginning treatment with corticosteroids.
* Biologics may reduce the body's ability to fight other infections as well. If you are prone to infections
or develop any signs of infection while taking these medications, such as fever, fatigue, cough,or the
flu, inform your doctor immediately.
* It may be inadvisable for people with heart failure to take any of these medications, so tell your doctor if you have any heart condition before starting this medication. Inform your doctor at once if you develop new or worsening symptoms of heart failure—namely shortness of breath or swelling of the ankles or feet.
* On rare occasions, blood disorders have been noted with anti-TNF agents. Inform your doctor if you develop possible signs such as persistent fever, bruising, bleeding, or paleness while taking infliximab, adalimumab, or certolizumab . Nervous system disorders also have been reported occasionally. Let your doctor know if you have or have had a disease that affects the nervous system, or if you experience any numbness, weakness, tingling, or visual disturbances while taking these medications.
* Although reports of lymphoma (a cancer of the lymphatic system) in patients taking anti-TNF agents are rare, they do occur more often than in the general population.
*
Progressive multifocal leukoencephalopathy (PML), a rare brain infection, has been reported with
natalizumab use. Natalizumab may also cause liver damage and allergic reactions.
* Patients with a medical condition that can weaken their immune system such as HIV infection or AIDS, leukemia or lymphoma, or an organ transplant should not take Natalizumab.
* Your physician will monitor you closely while you are on biologic therapy. It is not advisable to stop and then try to restart anti-TNF agents. To achieve and maintain remission, it is advisable to stay on the medication.


Updated 9/8/08

 

[Astra]

Thank you CrohnsMan
Lots of info there, especially for newbies, and something for us to keep, and go back to now and then
Maybe a Mod could put it up as a sticky for newbies enquiring about meds?
Welcome back!