Medication and treatments

Generic and brand names

Every drug has an approved generic or medical name, decided on by an expert committee. Many drugs are also known by a brand or trade name chosen by the pharmaceutical company making and selling that drug as a medicine. So, for example, the drug mesalazine (generic name) is also known as Octasa (brand name). Some drugs are sold in a generic form as well as in a branded form. If several companies market a drug, it will have several different brand names.

Does it matter which I have?

Medicines usually contain inactive ingredients as well as the main active ingredient, the generic drug. These help to formulate the medicine, that is, to make it into its tablet, cream, or liquid form. They can also be used, for example, to give tablets a particular colour or affect how long the tablets take to dissolve in the gut. Usually, for most prescription medicines, such small differences are unlikely to create any problems. Whether you are prescribed the branded medicine or a generic version of a drug, provided your dose contains the same amount of active ingredient, your medicine should have the same therapeutic effect. However, for a very small number of drugs, the differences in formulation may be more significant. For example, some of the different brands of mesalazine work in a slightly different way. For this reason, your doctor may decide to prescribe a particular brand rather than the generic version.

This is so that they can be taken in the way that helps them work most effectively. This is usually orally (by mouth) but may be topically (applied directly) or by injection. The most suitable form for you will depend partly on the area of the gut affected by your IBD and partly on the nature of the drug itself.

Oral drugs

Most of the drugs used for IBD have a tablet, capsule, or granule form, so they can be taken by mouth. Many people with IBD find this a convenient way to take their medication. It is easy for a doctor to change the dosage level of oral drugs. 

However, anything taken by mouth will dissolve very quickly, so many of the tablets and capsules have a special 'gastro-resistant' coating. This makes sure the drug is released in the right part of the digestive system - usually the small intestine (small bowel) or large intestine (colon). This is why it is important to follow instructions if you've been told to swallow tablets or capsules whole.

Topical treatment

Taking a drug topically means applying it directly to the affected part of the body. This can mean that the drug works more efficiently. Another advantage can be that other parts of the body are not so readily affected by the drug, and this can reduce possible side effects. In IBD, topical treatment is usually the most appropriate when the inflammation caused by IBD is in the rectum (a condition known as proctitis) or near the end of the colon.

One way of delivering topical treatment to inflammation in these areas is to use a suppository. This is a small bullet-shaped capsule of the drug in a waxy substance that will dissolve at body temperature. The suppository is inserted directly through the anus (back passage) into the rectum. As it dissolves, it releases the drugs in exactly the right area.

Another way of getting a drug directly into the rectum and colon is to take it as an enema - in a liquid or foam form, put into the rectum through the anus using a specially designed applicator. Foam enemas are often easier to retain than liquid enemas so can be particularly useful at the beginning of a flare-up when the gut is most sensitive. Liquid enemas can usually travel further along the colon, so will reach more of the inflammation, especially if taken just before lying down. Both steroids and mesalazine are sometimes given topically, using a suppository or enema. 

Injections and infusions

Some drugs are injected subcutaneously (under the skin) or intravenously (into a vein). Intravenous injections are often given through a drip using an infusion (a dilute form of the drug). Biologics such as infliximab and adalimumab cannot be taken orally so are always given by infusion or injection. Steroids may also be given intravenously to get a quick response in someone having a severe flare-up.

Before drugs are licensed in the UK, they go through rigorous research and clinical trials on thousands of people. This process can take many years. Drugs are licensed by the government’s Medicines and Healthcare Products Regulatory Agency (MHRA).

The MHRA is responsible for regulating all medicines and medical devices in the UK, ensuring they work and are acceptably safe. It gives permission and sets strict safety criteria for all clinical trials in the UK. It demands very high standards from medicines manufacturers, and will only issue a licence when it is satisfied that a medicine meets all its safety and quality requirements. The MHRA also continues to review the safety of drugs after licensing. As part of this process, it has introduced a Yellow Card scheme to encourage people to report any suspected side effects from medicines. 

It is possible that other drugs or medicine might interact with your IBD medication – and that this interaction could make your treatment less (or more) effective, or perhaps alter its side effects. So it is very important to tell your doctor and specialist IBD team about any other medicines, treatments or therapies you are taking.

This includes not only medication for other conditions but also any over-the-counter, herbal, or complementary medicines. It may also be a good idea to carry a list of all your medicines, including dosages, to make sure you don’t forget to mention something.

In general, the evidence suggests that active Crohn's or ulcerative colitis may do more harm during pregnancy than most IBD medicines, so most people with IBD are advised to continue taking their IBD medication during pregnancy.

However, a small number of drugs used for IBD should not be taken when trying to conceive a baby or by pregnant people. Male fertility can also be affected. 

If you are planning to have a baby or especially if you are already pregnant, it is important to check with your IBD team whether you need to change your treatment.

When you are first prescribed medication for your IBD, you will probably find it easy to remember to take it exactly as instructed, especially if it has an immediate effect on your symptoms. Once you feel better, you may be less focused on taking your tablets or applying your topical medicines and forget the odd dose. Or you may be tempted to stop taking it altogether, now you don’t feel so ill, thinking you don’t need it. A lot of people get fed up with having to take pills every day, maybe even several times a day – or feel they would rather do without such a regular reminder of their IBD.

These are understandable feelings, but many studies have shown that maintenance therapy (continuing to take medication even when you are well) is important and does reduce the chance of a flare-up. It can also mean that you are less likely to need to move on to taking additional or stronger drugs. There is also some evidence that some IBD drugs may help reduce the chances of developing another condition. For example, 5-ASA drugs may reduce the slightly increased risk of bowel cancer for some people with IBD. If you do miss taking a dose, don’t panic – the patient information leaflet that comes with your medication should tell you what to do. If you can’t find this, check with your doctor or nurse. If you are prone to forgetting things like taking tablets, try and make taking them part of your daily routine, like brushing your teeth or setting an alarm on your phone.

It is usually important to take the full dose to get the full effect. Some medicines must also be taken in particular ways – for example, at particular times of day, on an empty stomach, or with or after food. If your lifestyle makes it difficult for you to do this, try discussing it with your doctor. It may be that some compromise or alteration in the dose is possible. For example, if you are taking 5-ASAs, you may be able to change to take the full dose just once a day, which some people find easier. It is also worth talking to your doctor and/or your IBD nurse about any other worries you have about the amount of medicine you are taking or concerns about side effects. It may be that they can reassure you, or again, suggest changes that you find helpful.

There may be other options such as different size doses. Or it may be that a change in brand or form of drug would suit you better. With some drugs, just taking them at a different time of day can make a difference, for example, taking steroids before 11am can help reduce side effects because this follows the natural rhythm of steroids in the body.  It is important that you do not alter the dose of your immunosuppressant as this could cause you to be over-suppressing your immune system.

If you have lived with an ongoing medical condition for some time, you are quite an expert on what works for you. And, as a result, you may feel you would like to take a more active part in your treatment and be able to adjust your own medication when your symptoms begin to get worse or better. If so, discuss this with your doctor or IBD specialists. You may find they are happy to include this idea in a plan around what to do in the event of a flare-up.

See further information on the CCUK website: Drug treatments for Crohn's Disease and Ulcerative Colitis (crohnsandcolitis.org.uk).