Some of the drugs and medicines prescribed for IBD come in several different forms – for example as tablets, as granules, or as a liquid or foam.
This is so that they can be taken in the way that helps them to work most effectively. This is usually orally (by mouth) but may be topically (applied directly) or by injection. Which way is best will depend partly on the area of the gut affected by your IBD and partly on the nature of the drug itself.
Most of the drugs used for IBD have a tablet, capsule or granule form, so can be taken by mouth. Many people with IBD find this a convenient way to take their medication and it is easy for a doctor to change dosage levels if necessary. however, anything taken by mouth will start to dissolve very quickly, so many of the tablets and capsules have a special 'gastro-resistant’ coating. This makes sure the drug is released in the right part of the digestive system – usually the small intestine (small bowel) or large intestine (colon). This is why it can be important to swallow tablets or capsules whole and not to break or crush them.
Taking a drug topically means applying it directly to the affected part of the body. This can mean that the drug works more efficiently. Another advantage can be that other parts of the body are not so readily affected by the drug, and this can reduce possible side effects.
In IBD, topical treatment is usually most appropriate when the inflammation is in the rectum (a condition often known
as proctitis) or near the end of the colon. One way of delivering topical treatment to inflammation in these areas is to use a suppository. This is a small bullet-shaped capsule of the drug in a waxy like substance that will dissolve at body temperature. The suppository is inserted directly through the anus (back passage) into the rectum. As it dissolves, it releases the drugs in exactly the right area
Another way of getting a drug directly into the rectum and colon is to take it as an enema – in a liquid or foam form, put into the rectum through the anus using a specially designed applicator. Foam enemas are often easier to retain than liquid enemas so can be particularly useful at the beginning of a flare-up, when the gut is most sensitive. Liquid enemas can usually travel further along the colon, so will reach more of the inflammation, especially if taken just before lying down. Both steroids and aminosalicylates (5-ASAs) are sometimes given topically, using a suppository or enema.
If the inflammation is on the surface of the skin, an ointment or cream may be helpful. Tacrolimus, an Immunosuppressant is available in ointment form and may be used to treat perianal CD.
Some drugs are injected subcutaneously (under the skin), intramuscularly (into a muscle) or intravenously (into a vein). Intravenous injections are often given through a drip using an infusion (a dilute form of the drug). Biologics such as infliximab and adalimumab cannot be taken orally so are always given by injection. Steroids and some immunosuppressants may be also injected intravenously to get a quick response in someone having a severe flare-up.