Skip to main content

IBD medicines

On this page

Check the drug listings here to see whether you can increase IBD therapies safely.

Increasing therapies only applies if you are taking mesalazine (oral or rectal).

Do not increase steroid or immune-system 'adjustment' medicines without speaking to the IBD team first, as this could be unsafe.

This page outlines the types of medication available, which can be prescribed in various combinations.

There are two kinds of dose:

  • maintenance - when you don’t have symptoms
  • treatment - when you have symptoms
Medications

Mesalazine (5-ASA)

Patients with ulcerative colitis will usually be prescribed one of these preparations. There are several brands of mesalazine - each has a different dose and each releases differently in the bowel.

Mesalazine - oral

It's perfectly safe for you to increase your mesalazine therapy to treatment when you have symptoms but if you do, we ask that you increase therapy for 6 weeks. Some patients may need to stay on the treatment dose.

If you have not seen a definite improvement in your symptoms within 7 to 14 days, contact the IBD specialist team.

Pentasa

  • granules/tablets
  • treatment is 4 grams once a day
  • maintenance is 2 grams once a day

Salofalk

  • granules/tablets
  • treatment is 3 grams once a day
  • maintenance is 500mg, 3 times daily

Octasa

  • treatment is 4.8 grams in divided doses
  • maintenance is 1.2 to 2.4 grams once a day, or in divided doses

Asacol

  • tablets
  • treatment is 4.8 grams in divided doses
  • maintenance is 1.2 to 2.4 grams once a day, or in divided doses

Mezavant XL

  • tablets
  • treatment is 4.8 grams once a day
  • maintenance is 2.4 grams once a day

Mesalazine - rectal

If you have a supply of these suppositories or enemas and are familiar with how to use them, it is safe to start these, normally nightly for two weeks, to help control symptoms.

Symptoms should improve after a week or two but if they don't, contact the IBD specialist team. In some cases your flare may require help by using a steroid rectal preparation.

Pentasa

  • suppository: treatment is 1 gram once a day, for 4 weeks
  • enema: treatment is 1 gram once a day, for 4 weeks

Salofalk

  • suppository: treatment is 1 gram daily
  • enema liquid: treatment is 2 grams once a day
  • enema foam: treatment is 1 to 2 grams once a day

Steroids

Before starting an oral or rectal steroid, contact the IBD specialist team. The IBD team will decide which type of steroid and dose is best to treat you, and this will be discussed with you at the time your prescription is given to you.

It is important to remember that these medicines are not recommended as long term treatment and in many cases are only needed when IBD symptoms will not respond to increasing your current therapy.

The current medical treatments for both Crohn’s disease and ulcerative colitis are designed to spare you from systemic steroids like prednisolone with their potential side effects. Budesonide is a steroid which does not carry such a high risk of side effects.

Steroids - oral

Oral budesonides are steroids which target the site of inflammation in the bowel, whereas oral prednisolone (a systemic steroid) is distributed throughout the whole body.

Cortiment (Budesonide MMX)

  • treatment is 9mg daily for your ulcerative colitis flare

Budenofalk (Budesonide)

  • treatment is 9mg daily for your Crohn's flare

Entocort (Budesonide)

  • treatment is 9mg daily for your Crohn's flare

Prednisolone

  • treatment is for ulcerative colitis and Crohn's

Steroids - rectal

In some cases your flare may require help by using a rectal steroid preparation.

Prednisolone foam

  • treatment is 20-40mg daily

Budenofalk foam (Budesonide)

  • treatment is 2mg daily

Entocort enema (Budesonide)

  • treatment is 2mg daily

Hydrocortisone foam (Colifoam)

  • treatment is 100mg, 1 to 2 times daily

Immune-system 'adjustment' medicines

  • Always ensure you are taking these medications as prescribed by the IBD team. Do not adjust your dose. These are immunosuppressant medicines and you should not increase or decrease these therapies without discussing with the IBD specialist team.
  • If you have an active, confirmed infection, you should withhold this immune-adjustment medication and discuss with your GP or the IBD specialist team.

Blood monitoring

While on these therapies, blood monitoring is normally directed by your GP:

  • liver function
  • full blood count
  • urea and electrolytes
  • inflammatory markers

Your GP will have received a copy of the local Shared Care Guidelines. Failing to get blood tests done within the recommended guidelines is unsafe, and could mean therapy is withdrawn by either your GP or the IBD specialist team.

As a guide we recommend the following blood monitoring if your symptoms are stable:

Azathioprine and mercaptopurine

Blood tests should be performed at least every 12 weeks.

Methotrexate

Blood tests should be performed at least every 8 weeks.

Biologic drugs

  • Adalimumab
  • Golimumab
  • Infliximab
  • Ustekinumab
  • Vedolizumab

Blood tests should be performed every 8 to 12 weeks as directed by the IBD team.

Last updated: 2 September 2024

Next review date: 10 December 2024