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Choose a TopicAll ConditionsADD/ADHDAllergiesAlzheimer'sArthritisAsthmaBack PainBreast CancerCancerDentalDepressionDiabetesEye HealthHeart DiseaseHepatitisHIV/AIDSHypertensionMen's ConditionsMental HealthMigraines/HeadachesMultiple SclerosisOsteoporosisParkinson'sSexual ConditionsSkin & BeautyStrokeWeight ControlWomen's Conditions Health Topics | Symptoms | Medical Tests | Medications | Wellness | Support Organizations Examples How It Works Why It Is Used How Well It Works Side Effects What To Think About References Immunomodulators for inflammatory bowel disease Examples azathioprine (AZA) (Imuran) 6-mercaptopurine (6-MP) (Purinethol) methotrexate (Rheumatrex, MTX, Mexate) mycophenolate mofetil (CellCept) tacrolimus (Prograf) How It Works Immunomodulator medications, such as azathioprine (AZA), 6-mercaptopurine (6-MP), methotrexate, and mycophenolate mofetil, weaken or suppress the immune system, which in turn decreases inflammation in the digestive tract. These medications are used most often to prevent the body from rejecting a newly transplanted organ.Why It Is Used Immunomodulators are used for inflammatory bowel disease (IBD) that: Has not responded to other treatments. Can be controlled only with long-term use of corticosteroids. Immunomodulators may be tried to help you cut back on or stop using corticosteroids. How Well It Works Immunomodulator medications are effective against inflammatory bowel disease. AZA and 6-MP are used to maintain remission of symptoms in ulcerative colitis and Crohn's disease. Both medications are effective in treating fistulas in Crohn's disease. Tacrolimus can be used in Crohn's disease when corticosteroids do not work or fistulas develop. It also may be applied topically for Crohn's disease that affects the mouth or perineal area.1 Studies have shown that methotrexate improves IBD symptoms in those people who are dependent on corticosteroids.2 It appears that the benefits of methotrexate are greater for people with Crohn's disease than for those with ulcerative colitis. It may take 4 months or more for AZA and 6-MP to improve symptoms. The disease often comes back after you stop taking the medication. Methotrexate improves symptoms more quickly than 6-MP but has not been studied as extensively. Mycophenolate mofetil has been studied in active IBD, with mixed results; more data are needed to confirm its role.3Side Effects Side effects of immunomodulator medications include: Nausea, vomiting, diarrhea, or stomach ulcers. Rash. General feeling of being ill (malaise). Liver inflammation. Rare side effects include: Suppression of blood cell production (bone marrow suppression), which may increase the risk of infection or serious bleeding. Return to normal blood cell production may take several weeks after the medication is stopped. Fever. Inflammation of the pancreas (pancreatitis). This may occur with AZA and 6-MP. Extremely rare side effects of azathioprine include a possible increased risk of cancer. Mycophenolate mofetil may increase the risk of cancer of the lymph system (lymphoma) and other types of cancer. See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)What To Think About Regular blood tests are needed to check for effects these medications may have on the bone marrow, liver, and kidneys. Immunomodulator medications are less likely than corticosteroid medications to cause growth failure in children. If you are pregnant or want to become pregnant, talk to your doctor about whether you can take immunomodulator medications; some of these medications are used in pregnancy, but only when the benefit outweighs the potential risk of harm to the fetus. Methotrexate should not be used because it can cause birth defects and pregnancy loss. See a list of questions to ask your doctor about medications. References Citations Sands BE (2002). Crohn's disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 7th ed., vol. 2, pp. 2005–2038. Philadelphia: W.B. Saunders. Podolsky DK (2002). Inflammatory bowel disease. New England Journal of Medicine, 347(6): 417–429. Hanauer SB, Dassopoulos T (2001). Evolving treatment strategies for inflammatory bowel disease. Annual Review of Medicine, 52: 299–318.Credits Author nne Flagg Editor Renée Spengler, RN, BSN Associate Editor Lila Havens Associate Editor Landauer Primary Medical Reviewer Sandoval, DO- Internal Medicine Specialist Medical Reviewer J. Kahrilas, MD- Gastroenterology Last Updated 7/11/2003 ^back to top To Search the Help Last updated: July 11, 2003 Print-Friendly Version © 1995-2004, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. All Rights Reserved.This information is not intended to replace the advice of a doctor. Medscape for Physicians | Medscape for Healthcare Professionals Corporate | Contact Us Terms and Conditions | Privacy Policy and Agreement ©1996-2004 WebMD Inc. All rights reserved. Quote Link to comment Share on other sites More sharing options...
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