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Anti-Inflammatory Drugs for Crohn's Disease

When you have Crohn's disease, of course you want to prevent flare-ups and keep them away for good. Inflammation in your intestines causes symptoms like stomach pain and diarrhea. Anti-inflammatory drugs ease them and may even keep them away for number of years. Although they aren't a cure, they can help you feel so much better. Your doctor will help you decide which one is best for you.

What kinds of drugs are used to treat Crohn's disease?

There are several types of drugs used to treat Crohn's disease. The first step usually involves reducing inflammation. Many people are first treated with sulfasalazine (Azulfidine). Mesalamine (Asacol, Canasa, Pentasa) is another 5-aminosalicylic acid, or 5-ASA medication. Possible side effects of sulfasalazine and other mesalamine-containing drugs may include:

Anti-inflammatory medications for Crohn's disease

Anti-inflammatory medications that decrease intestinal inflammation are similar to arthritis medications that decrease joint inflammation. Examples of types of anti-inflammatory medications used in the treatment of Crohn's disease are:

  • 5 aminosalicylic acid (5-ASA) compounds such as sulfasalazine (Azulfidine) and mesalamine (Pentasa, Asacol, Dipentum, Colazal, Rowasa enema, Canasa suppository).
  • Corticosteroids that act systemically to decrease inflammation throughout the body.
  • Topical corticosteroids, for example, budesonide (Entocort EC). This class of corticosteroids has fewer side effects than systemic corticosteroids, which are absorbed into the body.
  • Antibiotics that decrease inflammation, for example, metronidazole (Flagyl) and ciprofloxacin (Cipro).

5-ASA oral and rectal medications for Crohn's disease

Sulfasalazine (Azulfidine)

Sulfasalazine (Azulfidine) was the first modified 5-ASA compound used in the treatment of Crohn's colitis and ulcerative colitis. It has been used successfully for many years to induce remissions among patients with mild to moderate ulcerative colitis. Most of the side effects of sulfasalazine include nausea, heartburn, headache, anemia, skin rashes, as well as hepatitis and kidney inflammation. In men, sulfasalazine can reduce the sperm count. The reduction in sperm count is reversible, and the count usually becomes normal after the sulfasalazine is discontinued or changed to a different 5- ASA compound.

Mesalamine (Asacol)

Asacol is effective in inducing remissions in patients with mild to moderate ulcerative colitis. It is effective when used in the longer term to maintain remissions. Some studies have shown that Asacol is also effective in treating Crohn's ileitis and ileo-colitis, as well as in maintaining remission in patients with Crohn's disease.

Mesalamine (Pentasa)

Pentasa is a capsule consisting of small spheres containing 5-ASA. Pentasa is sulfa-free. As the capsule travels down the intestines, the 5-ASA inside the spheres is released slowly into the intestine. Unlike Asacol, the active drug 5-ASA in Pentasa is released into the small intestine as well as the colon. Pentasa can be effective in treating inflammation in the small intestine and is currently the most commonly used 5-ASA compound for treating mild to moderate Crohn's disease in the small intestine.

Olsalazine (Dipentum)

Olsalazine (Dipentum) is a capsule filled with a drug in which two molecules of 5-ASA are joined together by a chemical bond. In this form, the 5-ASA cannot be absorbed from the stomach and intestine. Intestinal bacteria are able to break apart the two molecules releasing the active individual 5-ASA molecules into the intestine. Since intestinal bacteria are more abundant in the ileum and colon, most of the active 5-ASA is released in these areas. Therefore, olsalazine is most effective for disease that is limited to the ileum or colon.

Balsalazide (Colazal)

Balsalazide (Colazal) is a capsule in which the 5-ASA is linked by a chemical bond to another molecule that is inert and prevents the 5-ASA from being absorbed. This drug is able to travel through the intestine unchanged until it reaches the end of the small bowel and colon. There, intestinal bacteria split the 5-ASA and the inert molecule releasing the 5-ASA. Because intestinal bacteria are most abundant in the terminal ileum and colon, balsalazide is used to treat inflammation predominantly localized to the colon.

Crohn’s disease may be a challenging to manage. However, corticosteroids may be effective in reducing inflammation. Each corticosteroid has its own benefits, along with its own side effects. So, it’s important to consider with your doctor which treatment may be best for you.