What is Crohn’s Disease?
Crohn’s is a chronic case of inflammatory disease that tends to have an impact on the intestines. It mainly leads to breaking of the lining of both the small and the large intestines. This disease also affects the digestive system starting from the mouth to the anus. Crohn’s disease has no cure yet, but there are medications that are available to reduce the progression of the disease or bring about improvement in the symptoms. Once the person has the disease, it would fluctuate between intervals of activity, which is called relapse, and intervals of inactivity, which are called remission. It is mostly an inherited form of the disease; hence, if the relative had this disease in the past, there can be chances of an individual related to this person getting this disease as well.
Since, as previously mentioned, there is no cure for Crohn’s disease, the aim of medications is to induce remissions, minimize the side effects caused by the treatment, maintain remissions, and mainly improve the individual’s quality of life, so they can settle back into their daily routine. There are three categories of medications that can be used for treatment. The doctor would first consider various factors, keeping mind the severity of conditions, age, height, weight, and overall health of the individual.
- Anti-inflammatory medications, such as 5-ASA compounds and steroids
- Topical antibiotics
The main effects of anti-inflammatory medicines are to reduce the intestinal inflammation. One can opt for different types of anti-inflammatory medications, which can be used in treating Crohn’s disease:
- 5-ASA compounds or 5 aminosalicylic acids, such as sulfasalazine (Azulfidine) and mesalamine (Pentasa, Canasa suppository). These act in direct contact or they can be applied topically with the inflamed tissue so that the healing is effective.
- Steroids or corticosteroids also tend to act systematically without the requirement to be in direct contact with the damaged or inflamed tissue. They decrease the inflammation that is present throughout the body. Systemic steroids have predictable and important side effects if they are persistently used for a long term.
- Antibiotics, such as metronidazole and ciprofloxacine, can be used to decrease the inflammation.
Common Brands of Anti-Inflammatory Medicines
- Rowasa enema
5-ASA oral medication – Also called mesalamine, it is very similar to aspirin, which is an anti-inflammatory medication. This medication has been used for many years in the treatment of various medical conditions that are very much related to the inflammation of the tissues. However, aspirin has been found to be non-effective in treating Crohn’s disease and can tend to worsen the condition. Five-ASA has been effective in treating Crohn’s disease if this medication is given topically directly on the inflamed tissue or intestinal lining.
Mesalamine is one such example that is an enema containing 5-ASA, and it is effective in treating rectum inflammation. However, the solution of enema is not able to reach high enough so as to treat inflammation in the upper colon and the small intestine. Hence, for most of the patients who have Crohn’s disease that involves both the colon and ileum, 5-ASA must be taken orally. If 5-ASA is taken orally in pure form, then it gets absorbed in the stomach, as well as the upper small intestine. Very little of this would reach the ileum and colon. Therefore, for this medicine to be effective as an oral agent in getting Crohn’s disease treated, the 5-ASA has to be modified chemically so that the absorption from the stomach and upper intestines can be escaped. This would lead to the proper amount of 5-ASA reaching the colon and ileum.
Side-effects – There are fewer side effects of the 5-ASA, and it also does not reduce the sperm count. These medications are safe to be used for long term duration and are well tolerated. Patients allergic to aspirin should also avoid 5-ASA compounds, since these are chemically similar to aspirin. There have been certain cases of kidney and lung inflammation due to the use of 5-ASA compounds.
Hence, those patients who are suffering from kidney and lung related disorders should be cautious while using this medicine and inform the doctor well in advance if they have any medical conditions. It is also advisable that one carries out a blood test of the functioning of the kidneys before the treatment is started, and the same should be monitored periodically. There have been rare side effects, such as worsening cases of diarrhea, pain in the abdomen, and cramps.
Pentasa – Pentasa is in the form of a capsule which consists of small spheres of 5-ASA. This medicine is free from sulfa. As Pentasa medicine starts travelling down the intestines, the 5-ASA compounds that are present inside the spheres of the medicine are released slowly into the intestine. The active drug 5-ASA gets released into the small intestine as well as the colon. Thus Pentasa is known to be effective in the treatment of inflammation present in the small intestine.
Pentasa is also one of the commonly used medicines for treating mild to moderate cases of Crohn’s disease pertaining to the small intestine. In very rare cases, a patient who is suffering from Crohn’s disease has to undergo surgery so that they are relieved from the obstruction in the small intestine or to remove fistulae. The diseased portions of the intestines in most cases are removed while carrying out the surgery. Once the surgery is completed, the patients are free from the disease and its related symptoms.
This medicine is known to maintain remissions and also reduce the recurrence of the disease after the surgery. For the treatment of Crohn’s, usually one would be prescribed Pentasa in the form of four 250mg capsules that are taken for four times per day, thus making it a total of four grams in a day. For the maintenance of remission in patients after the surgery, the dosage of Pentasa ranges between three to four grams per day.
Olsalazine – Olsalazine is a capsule that is filled up with a drug in which two molecules of 5-ASA are combined together by a chemical bond. Hence, in this form, the 5-ASA cannot be absorbed by the stomach or the intestine. This medicine is known to be very effective for those diseases that are limited to the colon and ileum.
Sulfasalazine - This medicine is the first modified 5-ASA compound that has been used in the treatment of Crohn’s colitis. This medicine has been successfully used for many years to induce remissions among those patients who are suffering from mild to moderate cases of Crohn’s disease. To maintain the case of remissions, Sulfasalazine has been used for longer periods. Sulfasalazine consists of a 5-ASA molecule that has been linked chemically to another sulfapyridine molecule.
By connecting these two molecules, it prevents the absorption by the upper intestines and stomach. When Sulfasalazine reaches the colon and ileum, the bacteria that has been normally present in the ileum and colon tend to break the link present between the two molecules. After breaking away from the 5-ASA molecule, sulfapyridine readily gets absorbed in the body and later gets eliminated through the urine. To treat colitis, most of the active 5-ASA are still present in the colon and ileum. Side effects of Sulfasalazine are due to the presence of the sulfapyridine molecule.
The side effects would include headache, anemia, heartburn, rashes on the skin, nausea, and in rare cases, it can lead to hepatitis and inflammation of the kidney. In certain cases, when men take Sulfasalazine, it tends to reduce the sperm count, but this condition is reversible. Once Sulfasalazine is discontinued, the sperm count returns to normal. Sulfasalazine should not be used if one is allergic to any of the ingredients present in this medicine, if anyone is allergic to salicylates, such as aspirin, or sulfonamide, such as sulfamethoxazole.
Also, if anyone has a blood related disorder or blockage in the stomach, bowel, or urinary tract, then he or she should not use this medicine. Before using the medicine, there can be chances that it can lead to certain side effects or interact with certain drugs. Hence, inform the doctor if any of the below apply to you:
- If one is pregnant or planning to get pregnant
- If one is breastfeeding a baby
- If there are any medications being taken, whether prescribed or non-prescribed
- If there is any history of kidney or liver problems, fast heartbeat, certain kinds of heart related problems, stroke, breathing problems, such as asthma or COPD, having trouble while urinating, epilepsy, inflammation in the pancreas, or problems in the stomach or bowel movements
- If one has past history of infections, such as strep throat or an infection that recurs very frequently
- If the individual has a deficiency of glucose-6 phosphate
Below medicines can tend to interact with Sulfasalazine; hence, inform the doctor if you are taking any of the below medicines:
- The effectiveness of beta blockers, such as propranolol, folic acid, or digoxin, can be reduced with the intake of Sulfasalazine.
- There can be an increase in the risk of side effects of medications such as anticoagulants or methotrexate with the use of Sulfasalazine.
- The risk of crystals present in the urine can increase with the use of methenamine.
Sulfasalazine should be used exactly as prescribed by the doctor, or one can check the label of the medicine for information of the usage. Sulfasalazine should be used orally after meals. It should be taken with one full glass of water. It is recommended to consume water and keep yourself hydrated. The doctor can provide the instructions. Try and space the doses evenly throughout the day. The spacing of the doses should not be more than eight hours apart. Sulfasalazine should be taken on a regular basis at a fixed time so that it becomes a routine and one does not miss the dose. Also, it would benefit the individual in improvement of his or her symptoms. Even if one feels well and the symptoms improve, still continue to take Sulfasalazine.
Side effects of Sulfasalazine are mild pain in the stomach, nausea, vomiting, headache, and loss of appetite. If these symptoms continue for a long duration or become severe, then contact the doctor. The more serious forms of side effects of Sulfasalazine are severe allergic reactions, tingling sensation in the finger and toes, numbness in the toes and fingers, bloody diarrhea, swelling in face, lips, mouth, and throat, irregularity in the heartbeat, drowsiness, seizure attacks, persistent cases of nausea and vomiting, severe cramps and pain in the stomach, feeling unusually tired and weak, pale skin, hearing loss, decrease in the urination, pain in the chest, symptoms persisting to liver problems, and finding it difficult to walk.
Sulfasalazine can lead to signs of dizziness or drowsiness, and it can tend to get worse if the individual also consumes alcohol or certain types of medicines. Hence, one must use Sulfasalazine with caution. Avoid driving or carrying out any tasks that would need mental alertness. Sulfasalazine can also cause sunburn very easily; hence, one should avoid going too much out in the sun or to the tanning booths. Try to use sunscreen lotion as often as possible, and also wear protective types of clothing to avoid getting burns.
The skin or urine color can tend to become discolored due to the use of Sulfasalazine. It may look orange-yellow in color. This is quite normal and nothing to worry about. Sulfasalazine can also lead to a severe cases of skin reactions, which are called Stevens-Johnson syndrome. This syndrome can lead to very bad health related problems and may not go away. In some cases, it can lead to death. Hence, one should not delay getting medical help if there are certain symptoms, such as swollen or peeling skin that looks red in color.
One can also encounter severe cases of allergic reactions, such as problems related to the heart, kidneys, blood, lungs, muscles, and some can also have infections. Sulfasalazine is also known to affect the level of blood sugar in the body; hence, especially those who are diabetic, one should closely monitor his or her sugar levels. Children who are younger than two years of age are not advised to use this medicine.