Drug Therapy for Crohn's Disease and Ulcerative Colitis

There are several oral drugs available for the treatment of ulcerative colitis and Crohn's disease. The dosages listed represent the usual daily dosages; precise effective dosage varies from person to person and depends on many factors.

Do not make any changes to your medication without consulting your doctor. Instructions for administration of the drugs represent the typical way to take the medication. Your doctor's instructions may differ. Always follow your doctor's recommendations.

Oral Medicines for Crohn's and Ulcerative Colitis

  • Aminosalicylate anti-inflammatory compounds
    • Asacol (mesalamine, delayed-release)—1,600-2,400 mg; one 400-mg tablet 4x/day, two 400-mg tablets 2x/day, or two 400-mg tablets 3x/day. Swallow whole (do not crush, chew, or break). Take with or without food
    • Azulfidine, Azulfidine-EN (sulfasalazine)—2,000 mg; four 500-mg tablets 1x/day with food or after meals with a glass of water
    • Colazal (balsalazide)—6,750 mg; three 750-mg capsules 3x/day with or without food
    • Dipentum (olsalazine)—1,000 mg; two 250-mg capsules 2x/day with food or after meals
    • Lialda (mesalamine, delayed-release)—2.4-4.8 g; two to four 1.2-g tablets taken once daily with a meal. Swallow whole.
    • Pentasa (mesalamine, controlled-release)—4,000 mg; four 250-mg capsules 4x/day or two 500-mg capsules 4x/day with or without food. Swallow whole.
  • Corticosteroids
    • Entocort EC (budesonide)—6-9 mg; two or three 3-mg capsules 1x/day in the morning. Swallow whole (do not chew or break).
    • (prednisone)—40-60 mg; a combination of 1-, 2.5-, 5-, 10-, 20-, or 50-mg tablets 1x/day in the morning with food to prevent stomach upset
  • Immunomodulators
    • Imuran (azathioprine)—50-150 mg; one or more 50-mg tablets 1-2x/day. Take with food to reduce stomach upset.
    • Purinethol (mercaptopurine)—50-100 mg;one to two 50-mg tablets 1x/day
  • Antibiotics
    • Cipro (ciprofloxacin)—1,000 mg; one 500-mg tablet with or without food in the morning and evening
    • Flagyl (metronidazole)—1,000-2,000 mg; one or two 500-mg tablets 2x/day in the morning and evening with food or a glass of water or milk to reduce stomach upset

Patients who are allergic to aspirin should not take aminosalicylate anti-inflammatory compounds. Avoid alcohol while on these medicines to reduce the risk of dizziness and stomach bleeding. Azulfidine only: You'll need regular blood and urine tests to monitor the health of your blood, liver and kidneys.

Side effects of aminosalicylate anti-inflammatory compounds include headache, upset stomach, nausea, abdominal pain, diarrhea and gas. Azulfidine only: May cause skin or urine to turn orange-yellow. This is harmless and goes away when the medication is stopped. Call your doctor if you experience worsening stomach pain or cramping, worsening bloody diarrhea, rash, itching, yellowing eyes or skin, dark urine, fever, fatigue, headache. Asacol and Azulfidine only: Call your doctor if you notice intact or partially intact tablets in your stool.

Avoid consumption of grapefruit and grapefruit juice while taking corticosteroids; these foods can increase the amount of the medication in your blood. Avoid exposure to people with chicken pox or measles and get your doctor's permission before having any vaccinations. If you have diabetes, monitor your blood glucose levels more closely; corticosteroids can cause your blood glucose levels to rise. Do not stop taking corticosteroids abruptly; to go off the drug, you need to slowly decrease the dose over time to prevent extreme fatigue, weakness, stomach upset, or dizziness. Corticosteroids can increase your risk of osteoporosis; be sure to get 1,200-1,500 mg of calcium and 400-800 IU of vitamin D a day, and have your bone density measured on a regular basis.

Common side effects of corticosteroids include headache, nausea, stomach upset, dizziness, trouble sleeping and weight gain. Call your doctor if you exhibit signs of high steroid levels in your body: swelling of your face and neck, acne, bruising. Or if you have signs of infection: fever, fatigue, cough or flu-like symptoms.

Patients taking immunomodulators should have a blood test called a complete blood count (CBC) at least once a month to check for bone marrow suppression. Side effects include nausea, vomiting, diarrhea, loss of appetite, stomach pain, drowsiness and dizziness. Call your doctor if you experience unusual bleeding or bruising or signs of infection: fever, fatigue, cough or flu-like symptoms.

Patients taking Cipro to treat Crohn's disease or ulcerative colitis should drink plenty of liquids. Consumption of dairy products (milk, yogurt, or calcium-fortified juice) greatly reduces absorption. This antibiotic can cause sun sensitivity; use sunscreen and avoid excessive sunlight or sun lamps. Patients taking Flagyl should avoid alcohol for at least 1 day afterward; the drug slows the breakdown of alcohol, which can lead to nausea and vomiting. Flagyl also can cause sun sensitivity; use sunscreen and avoid excessive sunlight or sun lamps.

Side effects of Cipro include stomach upset, loss of appetite, diarrhea, nausea, headache, vision changes and dizziness. Call your doctor if you experience a rash or signs of peripheral neuropathy: pain, burning, tingling, numbness, weakness in your hands or feet.

Side effects of Flagyl include diarrhea, nausea, metallic taste in the mouth, darkened urine (which is harmless). Call your doctor if you experience unsteadiness, seizures, mental or mood changes, numbness or tingling of your hands or feet, painful urination.

Publication Review By: H. Franklin Herlong, M.D.

Published: 30 Mar 2011

Last Modified: 22 Sep 2015