IBD Research Unit

Prednisone

Why is this medicine prescribed?
Prednisone is a corticosteroid, similar to a natural hormone produced by the adrenal glands. It relieves inflammation associated with Crohn’s disease or ulcerative colitis.

How should this medicine be used?
There are many different ways that this medication may be taken. If your doctor instructs you to take prednisone once daily or every second day, take the dose with breakfast. If you must take several doses throughout the day, then space them evenly throughout the time that you are awake.

Do not stop taking this medication without talking to your doctor. It is likely that your doctor will slowly take you off the drug in order to prevent symptoms of withdrawal .

Take prednisone exactly as directed, and ask your doctor or pharmacist to explain anything you do not understand. Do not change the dose or frequency prescribed without instructions from your doctor.

What special precautions should I follow?
Before taking this medication, talk to your doctor and pharmacist about:

What should I do if I forget to take a dose?
Once daily regimen: Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Every second day regimen: If you remember the morning of the missed dose, take it as soon as you remember and continue on as usual.
If you remember in the afternoon or later, skip the dose, and begin a new schedule the following morning.

Several times daily: Take the dose as soon as you remember, and space the other doses evenly throughout the rest of the day.
If you remember at the time of the next dose, you may take a double dose.

What side effects can this medicine cause?
Side effects from prednisone may occur. Tell your doctor if these symptoms are severe or persist :

Call your doctor immediately if you experience any of these effects:

• back or hip pain
• vision problems
• a cold or infection that lasts longer than usual
• muscle weakness
• bloody or dark, tarry stool

What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat, light and moisture (not in the bathroom). Dispose properly of any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?
You can take this medication with food or milk if it causes stomach upset. You doctor may suggest a diet that is low in sodium, low in salt, high in potassium, and high in protein.

Alcohol and certain pain medications (aspirin, ibuprofen) can increase the likelihood of stomach upset or other stomach problems, and should be avoided.

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab test s to check your response to prednisone.

Methotrexate

Why is this medicine prescribed?
Methotrexate can be used in the treatment of some severe cases of Crohn's disease, in order to improve symptoms and decrease the dose of prednisone required.

How should this medicine be used?
Methotrexate is available as oral tablets or intramuscular injections. Methotrexate is typically given as a weekly injection for the treatment of Crohn's disease.

Take this medication exactly as directed, and ask your doctor or pharmacist to explain any part you do not understand. Do not change the dose or frequency prescribed by your doctor.

What special precautions should I follow?
Before taking this medication, talk to your doctor and pharmacist about:

What should I do if I forget to take a dose?
Do not take the missed dose, do not double the next dose. Continue the regular dosing schedule and contact your doctor.

What side effects can this medicine cause?
This medication can cause liver problems, therefore keep alcohol intake to a minimum. Methotrexate can rarely cause hair loss but this is very unusual at the doses used to treat Crohn’s disease. If it does occur the hair should return to normal after completing drug treatment.

The following side effects usually go away as your body adjusts to the medicine, however tell your doctor if these symptoms are severe or do not go away:

• Loss of appetite
• Nausea or vomiting
• Skin rash or itching
• Headache
• Unusual tiredness or weakness

Check with your doctor as soon as possible if any of the following occur:

• Yellowing of the eyes or skin
• Sores or ulcers in the mouth and on lips
• Black, tarry stools
• Blood in urine or stool
• Seizures
• Cough
• Fever or chills

What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat, light and moisture (not in the bathroom). Dispose properly of any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab test s to check your response to methotrexate and to monitor for side effects. You should have regular blood testing as long as you are taking methotrexate. Please discuss the precise scheduling with your doctor.

Do not take this medication if you are pregnant or breast-feeding. Both males and females must use adequate birth control while taking this medication to prevent pregnancy.

This medication will temporarily suppress your immune system, so be sure to take appropriate precautions such as:

• washing your hands before eating, and after using the washroom
• avoid touching your face (especially eyes, mouth, and inside the nose)
• avoiding people with infections (as much as possible)
• maintain a healthy diet and lifestyle
• practice good oral hygiene (ask your dental hygienist for tips)

Metronidazole

Brand Name: Flagyl

Why is this medicine prescribed?
Metronidazole is an antibiotic used to treat certain infections caused by bacteria. In the treatment of inflammatory bowel disease (IBD), it works by altering the bacteria in the intestines, which can help to decrease inflammation.

How should this medicine be used?
Metronidazole comes as a tablet to take by mouth, or as an intravenous (IV) injection.

Take metronidazole exactly as directed, and ask your doctor or pharmacist to explain any part you do not understand. Do not change the dose or frequency prescribed by your doctor.

What special instructions should I follow?
Before taking this medication, talk to your doctor and pharmacist about:

You should not drink alcohol while taking this drug. Alcohol may cause an upset stomach, vomiting, stomach cramps, head­aches, sweating, and flushing (redness of the face).

Plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen.
Metronidazole may make your skin sensitive to sunlight.

What should I do if I forget to take a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule.
Do not take a double dose to make up for a missed one.

What side effects can this medicine cause?
Although side effects from metronidazole are not common, they can occur. Tell your doctor if these symptoms are severe or persist:

• nausea or vomiting
• diarrhea
• loss of appetite
• dark or reddish-brown urine
• dryness of mouth; change in taste sensation; unpleasant metallic taste
• furry tongue

Check with your doctor as soon as possible if any of the following occur:
dizziness

• rash
• seizures
• numbness or tingling in hands and fee

What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat, light and moisture (not in the bathroom). Keep away from light. Dispose properly of any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to metronidazole.

Adalimumab

Brand Name: Humira

Why is this drug prescribed?
Adalimumab is used to treat moderate to severe Crohn’s disease if the patient has had an inadequate response to corticosteroids or immunosuppressants.

How is this drug taken?
Adalimumab is given as injections under the skin (subcutaneous injections) using preloaded syringes or pens. The first dose usually involves giving a totally of 4 injections on one day followed by 2 injections two weeks later. After that, injections are usually given once every 2 weeks. After appropriate training patients can often given the injections themselves or with the assistance of a properly trained family member or friend.

What special precautions should I follow?
Before taking this medication, talk to your doctor and pharmacist about:

What are the side effects of this medication?
Although side effects from infliximab are uncommon, they can occur. Check with your doctor or IBD nurse as soon as possible if any of the following side effects occur:

How should this medication be stored?

This medication must be stored in the refrigerator and must not be frozen. Keep this medication out of reach and sight of children.

Special Instructions

• before receiving this medication all patients should be tested for latent tuberculosis infection (a TB skin test and possibly a chest x-ray)
• if a patient receiving adalimumabtreatment is scheduled to undergo surgery, appropriate precautions may need to be taken
• do not receive any live vaccines while taking this medication (check with your doctor about whether a vaccine is live before taking it)

Adalimumab is an expensive treatment. Some insurance companies will cover part or all of the cost of the drug (check with your insurance company first). If you do not have private drug insurance coverage, ask your doctor or IBD nurse for alternative coverage options.