Overview
IBD and other GI disorders are treated with a wide spectrum of medications. Beyond biologics and small molecules, the following classes form the backbone of traditional drug therapy. Understanding how each medication works and when it is used helps you participate actively in your treatment decisions.
Key Uses
5-ASA agents (mesalazine, sulfasalazine): ulcerative colitis induction and maintenance
Corticosteroids (prednisone, budesonide): acute IBD flares — not for long-term maintenance
H2 blockers (famotidine): mild-to-moderate GERD, short-term acid control
Antidiarrheals (loperamide, cholestyramine): chronic functional diarrhoea, bile acid diarrhoea
Prokinetics (metoclopramide, domperidone): nausea, gastroparesis, reflux
GI antibiotics (metronidazole, ciprofloxacin, rifaximin): Crohn's fistulas, SIBO, IBS-D, pouchitis
IBS treatments (hyoscine, mebeverine, linaclotide): spasm, pain, constipation-predominant IBS
How They Work
5-ASA agents act locally on the colon lining to reduce inflammation; available as oral tablets, suppositories, and enemas
Corticosteroids are potent anti-inflammatories for inducing remission; never stop abruptly — taper required
H2 blockers reduce stomach acid by inhibiting histamine H2 receptors; faster onset than PPIs but less potent
Loperamide slows gut motility — NEVER use in severe acute colitis (risk of toxic megacolon)
Cholestyramine binds bile acids — used for bile acid diarrhoea after ileal resection or Crohn's of the ileum
Rifaximin works locally in the gut with minimal systemic absorption — ideal for SIBO and IBS-D
Prokinetics like metoclopramide should not be used long-term due to risk of tardive dyskinesia
Safety & Self-Care
Always ask your doctor before adding any medication, even over-the-counter drugs
Never stop a chronic medication on your own without consulting your medical team
Tell your doctor all medications you take, including supplements and herbal remedies
Sulfasalazine reduces folate absorption — take a daily folic acid supplement
Metronidazole: avoid alcohol completely during treatment — severe reaction
Keep an updated medication list and bring it to every appointment
Corticosteroids: take calcium and vitamin D supplements to protect bone density
Contact Your IMCC Team
Contact your IMCC team if you experience any new or troublesome side effects, symptoms worsen despite adherence to treatment, before travelling or pregnancy or any surgery, or when starting new medications prescribed by another doctor.
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