Inflammatory Bowel Disease Medications


Generic Name
Brand Name
Site of release
Notes
Dosage
Sulfasalazine*
Azulfidine
Salazopyrin
Pyralin
Colon
5-ASA
Supplement w/ Folic Acid
30-100mg/kg/day (max 4g) active colitis
25-80mg/kg/day (max 4g) for maint
(gradually increase dose over 1-2wks)
monitor for allergic reaction
Olsalazine
Dipentum
Colon
5-ASA
Not approved for <18y
Clinical trial - inferior to sulfasalazine (1)
Balsalazide
Colazide
Colazal
Colon
5-ASA
60-100mg/kg/day (max 4g) active colitis
30-100mg/kg/day (max 4g) for maint
Mesalamine
(Mesalazine)
Lialda
TI
Colon
5-ASA derivative
Enteric Coating (dissolves at pH>7)
60-100mg/kg/day (max 4g) active colitis
30-100mg/kg/day (max 4g) for maint
Mesalamine
(Mesalazine)
Asacol
TI
Colon
5-ASA derivative
Eudragit-S coating
60-100mg/kg/day (max 4g) active colitis
30-100mg/kg/day (max 4g) for maint
Mesalamine
(Mesalazine)
Apriso
TI
Colon
5-ASA derivative
60-100mg/kg/day (max 4g) active colitis
30-100mg/kg/day (max 4g) for maint
Mesalamine
Pentasa
Duodenum to Colon
5-ASA derivative
-microspheres w/i an ethylcellulose
semi - permeable membrane
60-100mg/kg/day (max 4g) active colitis
30-100mg/kg/day (max 4g) for maint
Mesalamine
Canasa supp
Rectum
(Suppository)
5-ASA derivative
500 - 1000mg PR daily
(Consider BID dosing)
Mesalamine
Rowasa
Rectum, Sigmoid colon
(Enema)
5-ASA derivative
4000mg/60mL PR daily
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Hydrocortisone
*Multiple*
Cortifoam
Rectum
(Rectal foam/ Enema)
Corticosteroid
100mg PR daily to BID
Budesonide
Entocort (PO)
TI
Colon
Corticosteroid

Age > 6y

Can open capsule,
If target is small bowel
9mg x 8wks followed by 6mg x 4wks maint

Age 10-19: 12mg x4wks then 9mg x 3wks
then 6mg x 3wks

(References: 2,3,4)
Budesonide
Uceris
Colon
Corticosteroid
Age > 6y
9mg x 8wks followed by 6mg x 4wks
(Discontinue at 12wks total)
Prednisone
Prednisone
Systemic
Costicosteroid
1-2mg/kg/day div q12 PO/IV
After 2wks, Taper over 4-8wks
Max 60mg/day
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Methotrexate

Systemic

combination Rx with
Biologic
Immunomodulator,
Antineoplastic, antirheumatic

Supplement w/ Folic Acid 1mg po qd
<30kg: 10mg once weekly
30-39kg: 15mg once weekly
40-49kg: 20mg once weekly
>50kg: 25mg once weekly
Azathioprine**
Imuran
Systemic
Immunomodulator

Obtain TPMT level prior to dosing
Int TPMT: 1-1.5mg/kg/day
Normal/hi TPMT: 2-3mg/kg/day
6-Mercaptopurine
6-MP
Systemic
Immunomudulator

***Risk of: T-cell lymphoma
Hepatosplenic T-cell lymphoma
Lymphoproliferative disorders
Other Malignancies
Int TPMT: 0.5-0.75 mg/kg/day
Normal/hi TPMT: 1-1.5mg/kg/day

*5-ASA
**Azathioprine

References:

  1. https://pubmed.ncbi.nlm.nih.gov/8102399/
  2. https://pubmed.ncbi.nlm.nih.gov/15095852/
  3. https://pubmed.ncbi.nlm.nih.gov/12548062/
  4. https://pubmed.ncbi.nlm.nih.gov/19229988/