Getting the best out of your medication

A pharmacist's advice

Steroids general notes

  • These are best taken in the morning, and should always be taken with food (except Budenofalk which is before food).
  • If you are also taking antacids such as Gaviscon or Peptac, avoid taking at the same time as your steroids as they can affect absorption; if possible try and leave at least 2 hours between administration of your steroid and antacid.
  • As soon as you are started on steroids, if you are prescribed high doses which might continue for a few months, it is worth requesting from your prescriber some Calcium and Vitamin D supplements (although you can also buy these over the counter). The steroids can cause bone thinning, and taking supplements could help prevent this.
  • It is normal to have sleepless nights/insomnia from the steroids and feeling hyper/have mood swings/depression from it. It does go away when you stop taking them. If necessary try over the counter sleeping remedies and if it gets too bad, mention it to your Doctor, and see if they can prescribe you something stronger – sleepless nights really don’t help when you already aren’t feeling well so it is important to try and get some good night’s rest.
  • If you have been on high dose steroids for more than 3 weeks, you should be given a “steroid treatment card” to carry with you. You should never stop steroids abruptly, but should reduce the dose slowly as per your Doctor’s instructions.
  • Budenofalk 3mg capsules – take half to an hour before meals with plenty fluid – initially usually given as 3mg three times a day.
  • Budenofalk 9mg sachets – take half to an hour before breakfast – ONCE daily dosing. Place granules on tongue and swallow whole, do not chew or crush.
  • Entocort 3mg capsules – Usually taken once a day in the morning.
  • Prednisolone – best taken in the morning with or after food.
  • Calcort (deflazacort) – best taken as a single morning dose.

Stomach protectors: Esomeprazole (Nexium), Omeprazole (Losec), Ranitidine (Zantac)

  •  Your Doctor may prescribe you a stomach protector to help control upper gastrointestinal symptoms. They may interact with some antibiotics (e.g. ciprofloxacin) so make sure to space out doses by at least 2 hours.

Antibacterials

  • Sometimes antibacterials are used during flares, most commonly ciprofloxacin and metronidazole.
  • Metronidazole – This should always be taken with food or after a meal to reduce common side effect of nausea. Consumption of alcohol in drinks and foods should be completely avoided during therapy.
  • Ciprofloxacin – this should not be taken at the same time as milk or yoghurt, as they can reduce the amount of drug absorbed by the body. Also, do not take at the same time as calcium supplements or antacids (take 1-2 hours before or 4 hours after).

Aminosalicylates (Pentasa, Asacol, Octasa, Salazopyrin)

  • ­If you have been prescribed a particular brand of aminosalicylate, and it is working for you, it is best to stay on the same brand unless there is a clinical reason to change.
  • You will need initial monitoring of bloods, but as time progresses, these will be less frequent. If you experience any unexplained bleeding, bruising, sore throat report to your doctor so that a blood test can be undertaken.
  • Ipacol, Asacol, Salofalk – do not take at same time as indigestion remedies, and swallow tablets whole.
  • Colazide, Mezavent – take with or just after food, and swallow whole.
  • Pentasa tablets – these can be dispersed in water if necessary but do not crush or chew.
  • Pentasa granules – place the granules on the tongue and wash down with some water or orange juice.
  • Salazopyrin – do not take at same time as indigestion remedies, and swallow tablets whole. They cause a harmless colouring of the urine and may also stain contact lenses.

Azathioprine (Imuran) & Mercaptopurine (Puri-nethol)

  • To reduce side effects, take the tablets with at least 200ml of liquid and during meals. If you find you feel nauseous, try dividing your dose with each meal.
  • They do not work immediately and can take 6-12 weeks before you notice any benefit.
  • Ensure to go for your blood tests as regularly as prescribed by your Doctor. Report any throat ulcerations, fever, infections, bruising, bleeding or other signs of myelosuppression.
  • Both azathioprine and mercaptopurine increase the skin’s sensitivity to sunlight, so you should use a sunscreen and avoid sunlamps or sunbeds.

Colofac (Mebeverine 135mg tabs)

  • This can help to alleviate colicky abdominal pain symptoms. The important thing is to take the tablets 20 minutes before meals with a sufficient amount of water.

Colofac MR (Mebeverine 200mg MR capsules)

  • These are modified release capsules and are usually taken twice a day (morning and evening).

Colpermin (peppermint oil capsules, Mintec)

  • These can help with symptoms of IBS. They should be taken 30-60 minutes before meals. If you forget, do not take after a meal.
  • Do not take at the same time as indigestion remedies.

Fybogel

  • This can sometimes be prescribed to help manage bowel function in colostomy or ileostomy patients.
  • They should preferably be taken after a meal and ensure adequate fluid intake throughout the day. If taken after the evening meal, it should not be taken just before going to sleep.

Methotrexate

  • If you find that it makes you feel nauseous, try taking the tablets e.g. just before bed, or ask to try the injection.
  • This requires you to have regular blood tests, and also report any symptoms or signs suggestive of infection, especially sore throats.
  • Remember that methotrexate is taken as a single ONCE A WEEK dose on the same day each week. If you have also been given folic acid to take, do not take on the same day as the methotrexate. It is also usually taken once a week (but some patients may take more often).
  • Methotrexate may increase the skin’s sensitivity to sunlight, so you should use a sunscreen and avoid sunlamps or sunbeds.

Colestyramine sachets (Questran sachets)

  • These are sometimes prescribed in Crohn’s patients or after ileal resection to help relieve diarrhoea.
  • As it may interfere with absorption of other medication you may be taking, ensure to take any other medicines at least 1 hour before or 4-6 hours after taking the colestyramine.

Humira (adalimumab)

  • The Humira injection can be painful on injection. Take your injection out of the fridge a few hours before you need to inject yourself and it should hurt less. Injecting the solution slowly also helps. It comes as a pen and a prefilled syringe, try them both and see what works for you. You may find it useful to numb the injection site with an ice pack prior to injecting it.
  • If you are travelling and need to take your injection with you, an injection can be kept out of the fridge for up to 14 days as long as it is kept under 25˚C and protected from light.
  • Ensure to have your regular blood tests as prescribed by your Doctor.

Remicade (Infliximab)

  • This will usually be given in a hospital setting as an intravenous infusion, and you will usually need to stay in hospital for 1-2 hours post infusion under observation for acute infusion-related reactions.

Simponi (golimumab)

  • This should be removed from fridge 30 minutes prior to injecting yourself so that it reaches room temperature. Do not shake the pen or syringe.

The Crohn's and Colitis Charity

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