January 8, 2008
Drug Treatment For Crohn's Disease - Medication Considerations
Making the decision to take drug treatment for IBD, as well as choosing what drug to take at what dose and for how long, can be very complicated. There is no standard treatment for IBD that is effective in all situations for all patients. Every patient and every situation is somewhat different. Decisions about medical therapy need to be tailored for each person to meet the nature of the disease, while taking into consideration personal circumstances. This typically involves consideration of the chance of improvement with therapy and the possible side effects or risks of therapy. For some people in countries, states, or provinces where medication is not paid for through private or public health insurance plans, the cost of the medication may also be a consideration in making treatment decisions.
Tailored Treatments
The lack of a standard treatment for IBD is also due to the fact that IBD sufferers vary widely with respect to the form of IBD they have, the location within the gastrointestinal tract affected, the severity of the disease, and the complications of the disease. Patients also vary widely with respect to the side effects they are willing to risk or able to tolerate. They may respond differently to the means of administering the drug — pills, liquid suspensions, injections under the skin, infusions into a vein, suppositories, or enemas. As a result, what might be the best treatment for one patient might not be the best treatment for another patient with the same disease severity, location, and complications.
Benefits vs. Risks Assessment
Any given person with IBD may be likely to respond positively to a given medication, but may not be willing to take the possible risk of certain rare serious side effects. Another person might be willing to accept a relatively high risk of side effects for the sake of receiving the most effective treatment. The final decision about medical treatment of IBD requires, under ideal conditions, a full discussion among the doctor, the patient, and, where necessary, the family.
Some medications are thought to have the potential to cause exacerbations or flares of IBD. Many of these medications are available only by prescription from a doctor. Every time you are given a new prescription ask your doctor what the effect of the new medication might be on your IBD and if it has any interaction with the other medications you might already be taking for your IBD. Your doctor may not have an answer right away but will consult a reference source or ask a colleague with more experience. With the hundreds and hundreds of available medications, it is very difficult for any one individual to know about all of the possible interactions or effects of all of the medications.
TIP:Doctor and patient should assess the risks of drug therapy, not only the common and usually less serious side effects, but also the more rare and more serious potential side effects. Side effects can generally be divided into two categories — those that occur more often the higher the dose of the drug taken and those that are unpredictable and can occur at any dose of the drug. The first category of side effect may not occur in the majority of patients treated with the medication in the usual dose range, but tends to be more common the higher the dose used. These side effects can sometimes be dealt with by reducing the dose of the drug. The second category of side effects does not seem to occur more frequently at higher drug doses. These side effects appear to be similar to an allergic reaction and usually mean that the drug cannot be used any more because the reaction may occur even at low doses.
Doctor-Patient Consultation
Some patients will ask the doctor "What do you think is best?" and then trust the doctor to make the final recommendation on their behalf based upon the doctor's knowledge and experience in treating IBD and any insight the doctor may have into the patient's individual circumstances and psychological makeup. Others may not be so compliant, finding that even an extensive discussion with the doctor about the treatment options is not sufficient. They will look for other sources of information, such as the Internet or other IBD patients, in order to try to make decisions for themselves. The reliability of these approaches to information gathering should be discussed with a health-care professional.
Drug Information Sources
Many physicians, clinics, and hospitals have preprinted sheets that outline the nature of the various medications used to treat IBD, including when they are to be used and what can be expected from their use, with information on how to recognize the possible side effects. Some pharmacies provide similar drug information sheets for patients at the time of drug dispensing. There are also some websites that offer similar drug information, but the quality of that information varies from site to site. If in doubt about the quality of the site and its information, check with your doctor.
Some medications also require specific monitoring with periodic blood tests, for example. The patient may need this information to make a treatment decision.
Whenever the treatment of IBD is discussed, the fact that it is a chronic and lifelong disorder must be considered. Although some medications may be very effective at controlling inflammation and symptoms for a short period of time — days or weeks — what is really needed are medications that can safely and effectively ensure that, once a disease flare is under control, the IBD sufferer will be less likely to experience a recurrence of disease flares.
