Taking medicines

• Medicines are used to treat Crohn’s and Colitis symptoms. They can help prevent your condition from getting worse or causing complications.
• It is important that you have all the information you need to make an informed choice before you decide to take a medicine.
• Some people with Crohn’s or Colitis use more than one medicine at a time to manage their condition. This is known as combination therapy.
• Some of the medicines prescribed for Crohn’s and Colitis come in several different forms. This is so that they can be taken in the way that helps them to work most effectively.
• Let your IBD team know if you get any side effects or are struggling to take your medicine. It might take some time to find the right medicine for you.

All medicines come with a patient information leaflet. These are produced by the manufacturer of each medicine and approved by the MHRA. They include instructions on how to take the medicine and information on possible side effects. Copies of patient information leaflets can be found on the electronic medicines compendium website.

The Association of the British Pharmaceutical Industry has details of companies that make prescription medicines. For companies that make over-the-counter medicines, visit the Proprietary Association of Great Britain website.

Many people with Crohn’s or Colitis use more than one medicine at a time to manage their condition. This is called combination therapy.

Combination therapy is sometimes given for a short time to help control a flare-up. For example, you might be prescribed steroids together with 5-ASAs or an immunosuppressant such as azathioprine.

Combination therapy can also be taken for a long time. There is evidence that taking certain medicines together can be more effective than taking them alone. A common combination therapy used is a biologic, such as infliximab, along with an immunosuppressant (azathioprine, mercaptopurine or methotrexate).

Combining some medicines may make them more effective. But, taking more than one medicine can also increase the risk of side effects. It is important to discuss the risks and benefits of combination therapy with your IBD team and decide on the right treatment for you.

Your IBD team might give you a choice of different medicines to treat your Crohn’s or Colitis. Before deciding to take any medicine, it is important that you have all the information you need to make an informed choice.

Our appointment guide has some questions you might want to ask your IBD team about the medicines being offered. It also has space to write down some questions of your own.

You may want to ask about:

• What the medicine is and why it is being offered to you
• The possible benefits and risks, including side effects
• Which form the medicine comes in and if you can choose which form you prefer
• How frequently it should be taken
• If it needs to be taken at a certain time of day
• How to store the medicine safely
• How long you need to take the medicine for
• How to safely stop taking it
• How long it usually takes to start working
• Whether the medicine contains any ingredients you are allergic to

If you are pregnant, breastfeeding or trying to conceive, it is also important you discuss this with your IBD team. Some medicines may not be suitable for you.

For more details see our information on pregnancy and birth, postnatal care and breastfeeding and reproductive health.

Some of the medicines prescribed for Crohn’s and Colitis come in several different forms. This is so that they can be taken in the way that helps them to work most effectively. This is usually by mouth (oral), but they may be applied directly to the body (topical) or taken by infusion or injection.

Oral medicines

Many medicines used to treat Crohn’s and Colitis come in a tablet, capsule or granule form. These can be swallowed by mouth. Anything taken by mouth will start to dissolve very quickly. Many of the tablets and capsules have a special ‘gastro-resistant’ coating. This helps stop the tablet from being broken down by the acid in your stomach. It makes sure the medicine is released in the right part of your gut– usually the small bowel or colon.

Some tablets and capsules should be swallowed whole and not broken or crushed. Some medicines need to be taken before or with food. Your IBD team or pharmacist will let you know how your medicine should be taken. Details can also be found on the information leaflet that comes with your medicine.

Topical treatment

Topical treatments are applied directly to the affected part of the body.

Topical treatment is usually recommended if the inflammation is in the lower part of the colon or rectum. Steroids and aminosalicylates (5-ASAs) are sometimes given topically, using a suppository or enema.

Suppositories

One way of delivering topical treatment to inflammation in these areas is to use a suppository. This is a small bullet-shaped capsule of medicine. It is usually covered in a waxy substance that will dissolve at body temperature. Follow the instructions on the leaflet inside your medicine packet. Suppositories are inserted directly into your bottom (anus). As it dissolves, it releases the medicine in the right area.

Enemas

Another way of getting a medicine directly into the rectum and colon is to take it as an enema. These can come as a liquid or a rectal foam. Enemas and rectal foams are put into the rectum through your bottom (anus) using an applicator. Rectal foams and enemas work better when you keep the liquid or foam inside your bottom for as long as possible. Follow the instructions on the leaflet that comes with your medicine. It will have instructions on how to use the rectal foam or enema.

Some people may find using suppositories and enemas slightly uncomfortable and they can take a while to get used to. If you are struggling to use suppositories or enemas, speak to your IBD team.

Ointments and creams

If the inflammation is on the surface of the skin, an ointment or cream may be helpful. Tacrolimus is a medicine available in ointment form and may be used to treat perianal Crohn’s.

Injections and infusions

Some medicines have to be given by injection or infusion because they may be poorly absorbed or ineffective if taken by mouth (orally). Injections usually come as pre-filled syringes or pens.

There are different types of injections:

• Subcutaneous: an injection given under the skin, usually in your thigh or stomach.
• Intramuscular: an injection given into a muscle.
• Intravenous (IV): into a vein. Intravenous infusions are given through a drip into a vein, usually in your arm. You go to a hospital or clinic to have it.

If you are having injections, you will usually need to have an infusion at the hospital for your first dose. This is followed by injections given at home. Your doctor or nurse can teach you how to inject yourself at home. Or they could teach a family member or friend to do it for you.

Steroids may be given by infusion to get a quick response if you are having a severe flare-up.

It is possible that other medicines might interact with your Crohn’s or Colitis medicine. This could make your treatment less effective, or change the side effects you get. Read our individual medicine information or the patient information leaflet that came with your medicine to see if there are any interactions with your medicine. You can also find copies of patient information leaflets on the electronic medicines compendium website.

Before new medicines are used in the UK, they go through strict research and clinical trials on thousands of people. This process can take many years. Read about how we talk about the effectiveness of medicines for more information on clinical trials.

In the UK, medicines and medical devices are licensed by the Medicines and Healthcare Products Regulatory Agency (MHRA).

The MHRA makes sure all medicines are effective and meet strict safety standards. The MHRA demands very high standards from medicines manufacturers. It will only issue a licence when it is satisfied that a medicine meets all its safety and quality requirements. Visit the MHRA website for more information about the work that it does.

All medicines are made and prescribed to help you get benefits, such as reducing your symptoms and preventing flare-ups. All medicines can also cause unwanted effects called side effects, but not everyone gets them. It is important to understand the possible side effects of your medicine. These may be mild and go away once your body has adjusted to the medicine. Or they may be more severe and mean you have to stop taking the medicine and need further treatment.

Taking certain medicines used to treat Crohn’s and Colitis may mean you need to take extra care in your daily life. For example, medicines that affect the immune system can make it harder for your body to fight off infections. If you are not sure whether your medicine affects your immune system, read our medicine information or ask your IBD team.

Vaccines

You should avoid live vaccines if you are taking a medicine that weakens your immune system. If you are not sure if this includes you, read the “vaccinations” section in the relevant medicine information or ask your IBD team.

You can have non-live vaccines such as the flu, pneumococcal and COVID-19 vaccines.

Live vaccines used in the UK include:

• TB vaccine
• Shingles vaccine – but a non-live version is also available
• Chickenpox vaccine
• Measles, mumps and rubella vaccines
• Nasal flu vaccine used in children – but the injected flu vaccine used in adults is not live
• Rotavirus vaccine
• Yellow fever vaccine
• Oral typhoid vaccine – but the injected typhoid vaccine is not live

If someone that you live with is due to have a live vaccine

Live vaccines contain weakened strains of virus or bacteria. There is a small risk that people who have received live vaccines could spread (transmit) the weakened form of the virus to close contacts who are immunosuppressed and cause an infection. Most of the live vaccine viruses used in the UK do not transmit to contacts or can be minimised by following simple precautions such as:

• Careful hand washing before direct contact with the person who has had the vaccine, and before preparing food.
• Covering any rashes until the rash is dry and crusted.

Sun safety

Some medicines used to treat Crohn’s and Colitis can increase how sensitive your skin is to sunlight. In some cases, they can increase your risk of developing skin cancers.

Find out more in the “special precautions” section in our individual medicines information.

You can protect your skin from the sun by using sunscreen, covering your skin and wearing a hat when you are out in the sun. You should avoid using sun beds. The NHS has more information on sun safety.

The patient information leaflet that comes with your medicine will also tell you whether you need to take any special precautions.

If you are travelling overseas, make sure you take enough medicine for your whole trip, plus extra in case of delays. Some places have restrictions on what medicines you are allowed to bring into the country. Check with the embassy of the country you are visiting before you travel. Keep your medicines in their original packaging, along with the patient information leaflet. You might also need a copy of your prescription and a covering letter from your doctor.

When you are travelling, it is important to be aware of the temperature your medicines need to be stored at. Copies of patient information leaflets can be found on the electronic medicines compendium website.

Our information on travelling with Crohn’s or Colitis has more details on transporting and storing your medicines while travelling.

It can be very helpful to build a good relationship with your IBD team, so that you can ask about your options and discuss any concerns and worries. Talking about your feelings and symptoms will help them understand your needs and what is or is not working well for you. Our appointment guide can help you note down how you are feeling, and any questions you might have for your IBD team at your next appointment.

You can also talk to your GP or local pharmacist. Pharmacists can often answer any questions you have about medicines.