Pharmacologic Treatment

As IBD cannot be cured by medications, the focuses of pharmacologic management are the induction and maintenance of remission.

Five classes of drugs (prescribed either on their own or in combination with one another) can be used to assist in achieving these goals:

Aminosalicylates

Work by

Aminosalicylates work by lessening the creation of, or blocking, the effects of leukotrienes, the substances produced by the immune system that can cause the symptoms of IBD.

Suitable for

Aminosalicylates are suitable for treating mild-to-moderate episodes of ulcerative colitis and Crohn’s disease, as well as preventing relapses and maintaining remission. Less effective in Crohn’s disease.

Interesting drug fact

Aminosalicylates come in variety of preparations, each designed to deliver the drug to a particular intestinal segment.

Antibiotics

Work by

Antibiotics work by decreasing intestinal bacterial concentrations and selectively inhibiting or eliminating the pro-inflammatory bacteria thereby decreasing tissue evasion.

Suitable for

Antiobiotics are suitable for mild to moderate episodes of disease, as well as maintenance of remission.

Interesting drug fact

Ciprofloxacin has been extensively studied and its safety profile is well documented in more than 32,000 publications.

Corticosteroids

Work by

Corticosteroids work by blocking white blood cells from attacking tissue and decreasing inflammatory causing substances immune cells produce.

Suitable for

Corticosteroids are suitable for treating moderate to severe disease activity, and are an effective therapy in inducing remission of symptoms.

Interesting drug fact

Corticosteroids are synthetically produced hormones that are very similar to cortisol (a hormone which is naturally produced in the adrenal cortex: the outer layer of the adrenal gland). Cortisone was first identified by the American chemist Edward Calvin Kendall while a researcher at the Mayo Clinic. He was awarded the 1950 Nobel Prize for Physiology or Medicine along with Philip S. Hench and Tadeus Reichstein for the discovery of adrenal cortex hormones, their structures, and their functions.

Immunomodulators

Work by

Immunosuppressive drugs work by suppressing the body’s immune system. Specifically, they inhibit cytotoxic T cells and natural killer cell function.

Suitable for

Immunosuppressive drugs are suitable for mild to moderate disease.

Interesting drug fact

AZA/6-MP were initially developed as agents used to suppress cell growth and immune responses for transplant rejection and autoimmune diseases.

Biologic therapies

Work by

Fibre is important to include in the diet to maintain luminal health of the bowel and normal bowel actions. Dietary fibre is found in plant products, and includes any food material that we are unable to digest completely.

Suitable for

Biologic therapies are suitable for use as an induction therapy in patients with moderate to severe active disease who did not respond to standard treatment (aminosalicylates, corticosteroids, immunosuppressive agents), and as maintenance treatment in patients who responded to induction therapy.

Interesting drug fact

Infliximab is a chimera, one-fourth mouse protein, and three-fourths human. It was first introduced in 1998 and is the first biological agent to be used in Crohn’s disease.

Information that dictates choice and dose of medication is: disease severity (mild, moderate, and severe) and location within the GI tract.

Pharmacologic treatment: issues

Often patients have issues with adhering to their medical regime. The following is a list of some of the common barriers to non-adherence and some tips to overcome them.

Issue	Tips
Cost	Health care card, The Medicare Safety Net provides families and individuals with financial assistance for high out-of-pocket costs for out-of-hospital Medicare Benefits Schedule (MBS) services. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year. Please see http://www.medicareaustralia.gov.au/public/services/msn/index.jsp for more information.
Forgetting	Purchase a pill box to store meds. Set aside a time to take pills and get into a habit of following this routine each day.
Concerns about an adverse drug event	Questions surrounding this should be raised with the doctor.
Negative beliefs (thinking medication is not needed, will not help, is not wanted or causes stigma)	These issues should be raised with the doctor. It’s important to realise that because IBD is a chronic condition, it is advisable to stay on medications even when feeling well.
Psychological impact of side effects (e.g., moonface)	These issues should be raised with the doctor.

Other Helpful Medications

Other medications that may be helpful in relieving the signs and symptoms of IBD include:

Anti-diarrheal drugs: Work by slowing down bowel movements. Examples of drugs include: Imodium, Lomotil, and codeine phosphate. Care with their use with colitis (see above)
Laxatives: There are different types, some work by stimulating the bowel muscles (stimulant laxatives), which in turns speeds up the process of waste elimination; others increase the amount of water that stays in your feces (osmotic laxatives); whereas bulk forming laxatives soften feces
Pain relievers (analgesics). In some circumstances, acute and chronic pain may be treated using pain medications (or analgesics). Three categories of pain medications are used to help management pain, these are: opioid (narcotic) analgesics, non-opioid analgesics, and adjunct analgesics.

For more detailed information about any medications you are taking, please go to the Australian Government National Prescription Service website: http://www.nps.org.au/