Pharmacists can play a key role in the management of patients with bowel inflammatory disease (IBD) through medicines management.
IBD includes the 2 conditions, Crohn’s disease and ulcerative colitis (UC), involving chronic inflammation in the gastrointestinal tract (GI). Crohn’s disease is inflammation that may affect any part of the GI corridor.1 Inflammation occurs in the large intestine (colon) and in the rectum for UC.2 Symptoms of IBD include diarrhea, fever, abdominal pain, bloody stool, reduced appetite, and weight loss.2
Treatments and Counseling Points
Treatment for IBD usually involves pharmacy or surgery. An important point of counseling is to avoid anti-inflammatory drugs such as ibuprofen or naproxen, as these medications can make IBD symptoms worse and increase the risk of bleeding.3,4 Pharmacists can recommend acetaminophen to patients who need pain relief. College Gastroenterology American clinical guidelines (ACG) recommends management based on disease size, severity and prognosis.3,4
Many of the same medication can be used to treat UC and Crohn’s disease. Patients with mild UC can be treated with inflammatory medicines such as aminosalicylate therapies (5-ASA) as a first step in the treatment process.3 The 5-ASA medicines (eg sulfasalazine, mesalamine, olsalazine) are generally well accepted, and the adverse effects may include headaches, dizziness, abdominal pain, vomiting, rash, and fever. Sulfasalazine has been shown to be effective in treating moderate mild symptoms of colonic Crohn’s disease.4
Corticosteroids (eg prednisone, budesonide) are usually kept for patients with moderately severe disease or Crohn’s disease.3,4 However, long-term use is not recommended due to the high risk of adverse effects, including hypertension, increased blood glucose, cage, weight, osteoporosis, and psychiatrist. One study showed that over 15% of patients with IBD used excessive steroids.5
Anti-tumor necrosis medications (anti-TNF) such as adalimumab (Humira), golimumab (Simponi), or infliximab (Remicade) are the medications that can reduce symptoms and cure the intestine in patients with UC.5 Adalimumab, certolizumab pegol (Cimzia), and infliximab are the most effective anti-TNF therapies for treating Crohn’s moderately severe disease.6 These medicines can cause an injection site reactions, it increases the risk of developing infections, and there may be changes in the function of the liver so patients should have closely monitored.
There are inexpensive products available for many of the anti-TNF drugs, which may make this medication more affordable for patients. Vedolizumab (Entyvio) is biological and this is an alternative to UC disease and Crohn’s disease in patients who have failed other medicines.3,4 Another option for the UC is Tofacitinib (Xeljanz), an immune drug that reduces inflammation.3 The FDA added a Box Box Warning regarding the increased risk of patients taking tofacitinib 10 mg dose twice a day and discussed that this medication should be booked as a second line therapy for people who have failed or cannot. anti-TNF to tolerate.6 Natalizumab (Tysabri) is effective in Crohn’s disease in patients who do not respond to normal boundaries, but is associated with rare brain disease called leukoencephalopathy multilateral.4 Individuals must be registered in a special register to use the medication. Ustekinumab (Stelara) for Crohn’s disease is used quite severely by other therapies and has received FDA approval on 21 October, 2019 for UC.7