Side Effects of Selected Medications for Crohn Disease
Medication | Some Side Effects | Comments |
|---|---|---|
Aminosalicylates | ||
| Common: Nausea, headache, dizziness, fatigue, fever, rash, and, in men, reversible infertility Uncommon: Inflammation of the liver (hepatitis), pancreas (pancreatitis), or lung (pneumonitis) and hemolytic anemia | Abdominal pain, dizziness, and fatigue are related to dose. Hepatitis and pancreatitis are unrelated to dose. |
| Common: Fever and rash Uncommon: Pancreatitis, inflammation of the pericardium (pericarditis), and pneumonitis For olsalazine: Watery diarrhea | Most side effects caused by sulfasalazine may occur with any of the other aminosalicylates but much less frequently. |
Steroids | ||
Prednisone | Diabetes mellitus, high blood pressure, cataracts, osteoporosis (decreased bone density), thinning of skin, mental problems, acute psychosis, mood swings, infections, acne, excessive body hair (hirsutism), menstrual irregularities, gastritis, and peptic ulcer disease | Diabetes and high blood pressure are more likely to occur in people who have other risk factors. |
Methylprednisolone | ||
Budesonide | Diabetes mellitus, high blood pressure, cataracts, and osteoporosis | Budesonide causes the same side effects as prednisone but to a lesser degree. |
Immunomodulating medications | ||
| Anorexia, nausea, vomiting, general feeling of illness, infection, cancer, allergic reactions, pancreatitis, low white blood cell count, bone marrow suppression, liver dysfunction, and increased risk of lymphoma | Side effects that are usually dose dependent include bone marrow suppression and liver dysfunction. Interval blood monitoring is required. |
Methotrexate | Nausea, vomiting, abdominal distress, headache, rash, soreness of the mouth, fatigue, hair loss, scarring of the liver (cirrhosis), low white blood cell count, and infections | People should take 1 milligram of folic acid daily. Liver toxicity is likely related to the dose and length of treatment. Methotrexate also causes abortion and birth defects during pregnancy, so it is not prescribed for anyone who is pregnant or may become pregnant. People with the potential for pregnancy who are taking methotrexate should be using an effective method of birth control. |
Cyclosporine | High blood pressure, nausea, vomiting, diarrhea, kidney failure, tremors, infections, seizures, neuropathy, and development of lymphomas (cancers of the lymphatic system), headaches, leg cramps, and pins-and-needles sensations | This medication is mainly for people with fistulas. Side effects become more likely with long-term use. |
Tacrolimus | Similar to cyclosporine | This medication is closely related to cyclosporine and shares a number of its side effects. |
Biologic agents | ||
Infliximab | Infusion reactions, infections, cancer, abdominal pain, liver dysfunction, and low white blood cell count | Infusion reactions are potentially immediate side effects that occur during the infusion (such as fever, chills, nausea, headache, itching, rash, hives, decreased blood pressure, or difficulty breathing). People should be screened for tuberculosis and hepatitis B before initiating treatment. |
Adalimumab | Pain or itching at the injection site (hypersensitivity reactions), headache, infections, and cancer | Side effects are similar to those of infliximab except adalimumab is given under the skin (subcutaneously) and so does not cause infusion reactions. Hypersensitivity reactions that occur at the injection site include pain, rash, itching, and hives. More severe hypersensitivity reactions are possible. |
Certolizumab | Similar to infliximab and adalimumab | Certolizumab works in a similar way as and causes side effects similar to those of infliximab and adalimumab. It is given subcutaneously. Some doctors prefer this medication over infliximab and adalimumab for people who are pregnant and/or nursing |
Vedolizumab | Infections, hypersensitivity reactions, and common colds | This medication has a theoretical risk of progressive multifocal leukoencephalopathy (PML). |
Natalizumab | Infections and hypersensitivity reactions | Use of this medication is restricted because of a known risk of PML. |
Ustekinumab | Infections and hypersensitivity reactions | This medication is given only if treatment with another medication does not work. |
Mirikizumab | Increased risk of upper respiratory infections, cold sores, other infections, injection site reactions (pain, redness, or swelling), headache, joint pain | People should be screened for tuberculosis before treatment. This medication should not be used in people with certain active infections. Liver enzymes and bilirubin are checked before treatment. Age-appropriate vaccinations should be completed before starting treatment. Live vaccines must be avoided during treatment. |
Risankizumab | Infections, headache, fatigue, common cold | Most of these side effects will improve within a couple of weeks |
Guselkumab | Hypersensitivity reaction, increased risk of upper respiratory and other infections | People should be screened for tuberculosis before treatment. This medication should not be used in people with certain active infections. Liver enzymes and bilirubin should be checked before and during treatment in people with inflammatory bowel disease. Age-appropriate vaccinations should be completed before starting treatment. Live vaccines must be avoided during treatment. |
Small-molecule agents | ||
Upadacitinib | Increased risk of elevated cholesterol levels, headache, herpes zoster (shingles) infection, and other infections Other rare side effects include increased risk of blood clot, heart attack, and stroke. | This medication may be given when there has been an inadequate response or intolerance to 1 or more tumor necrosis factor (TNF) inhibitors (such as infliximab and adalimumab). |
Etrasimod | Increased risk of infections, decreased white blood cell count | This medication is not for use in patients with history of heart attack or unstable angina, heart failure, stroke, and some heart rhythm problems. |