Budesonide, Rinvoq, and More: 8 Oral Crohn’s Disease Medications

If you find yourself having worsening symptoms of Crohn’s disease, you may be experiencing a flare-up. Thankfully, many Crohn’s disease medications are available to help you feel better and achieve remission. Some are oral pills, while others are biologics that are injected or infused into your body. And sometimes, a combination of medications might be needed.

Oral medications are convenient to use when possible. Aminosalicylates, corticosteroids (steroids), and immunomodulators are all common choices to manage this inflammatory health condition. Antibiotics, over-the-counter (OTC) medicines, and newer medications like Rinvoq (upadacitinib) can also make a difference when called upon.

The best choice for treating Crohn’s disease depends on many factors. The part of your gastrointestinal (GI) tract that’s affected and your severity of inflammation are important considerations. Let’s take a look at eight oral Crohn’s disease medications and when healthcare providers may prescribe them.

Keep in mind: Crohn’s disease commonly affects children. Some people have Crohn’s while pregnant or nursing, too. Your healthcare provider can help find treatments safest for these situations. The medications discussed here focus on general usage in adults.

1. Budesonide

Budesonide (Entocort EC, Ortikos) is a steroid used to treat flare-ups from Crohn’s disease. You may take once-daily budesonide if you have Crohn’s disease in a specific area of the intestines. Entocort EC is available as 3 mg capsules, while Ortikos is available as 6 mg and 9 mg capsules.

This medication is fast-acting. So you may notice a difference in your symptoms within days of starting the medication. Steroids can provide short-term relief, but experts generally don’t recommend taking them for longer than 2 to 4 months at a time. This is mostly because of their potential side effects. However, budesonide has fewer side effects than many other steroids.

Good to know: The specific versions of budesonide that treat Crohn’s disease have a delayed-release mechanism. They need to stay intact to work as intended; so don’t open, crush, or chew the capsules.

2. Other corticosteroids

Budesonide isn’t the only steroid for Crohn’s disease. Other steroids can reduce inflammation and induce remission of active Crohn’s disease, too. In fact, steroids, such as prednisone and methylprednisolone (Medrol), work better when your GI inflammation isn’t limited to one specific area. Your symptoms may start to improve within days of starting one of these oral steroids.

Again, steroids should only be used for the short-term management of Crohn’s disease. This is because they have many side effects that can affect your health and quality of life. Some of the potential long-term side effects of steroids include:

• Weight gain

• Weaker bones

• Higher risk for infections

• High blood pressure

• High blood glucose (sugar)

• Mood and sleep problems

• Cataracts and glaucoma

3. Sulfasalazine, mesalamine, and olsalazine

Sulfasalazine (Azulfidine), mesalamine (Lialda, Apriso, others), and olsalazine (Dipentum) are aminosalicylate medications. They’re used to improve inflammation (swelling) in mild to moderate Crohn’s disease — especially if you only have inflammation in the colon.

Sulfasalazine is available as a 500 mg tablet. The usual dose is 1 tablet 4 times a day. Olsalazine is available as a 250 mg capsule, with a recommended dosage of 2 tablets twice daily. Mesalamine comes as several different brand names, with dosing varying per medication.

As with all medications, some side effects are possible. Sulfasalazine often leads to appetite loss, upset stomach, and headache. It can also stir up trouble if you have a sulfa allergy. Mesalamine can cause watery diarrhea, skin rashes, and problems with your blood or kidneys — but these aren’t common. Stomach cramps and diarrhea commonly occur with olsalazine.

Good to know: These medications are used off-label for Crohn’s disease — meaning the FDA has not approved them for this use. They’re more effective for ulcerative colitis, but sometimes they’re also used for Crohn’s.

4. Azathioprine and mercaptopurine

Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan) are immunomodulators used off-label for moderate to severe Crohn’s disease, often in combination with a biologic medication. They help with swelling and irritation in your digestive tract by lowering your immune response.

Unlike steroids, these treatments don’t start working right away. It can take up to 3 months to notice an improvement in symptoms after starting an immunomodulator. They’re often given with a faster-acting medicine, such as a steroid.

Azathioprine is available as a 50 mg tablet, but lower doses are sometimes used. Mercaptopurine is also available as a 50 mg tablet. Azathioprine and mercaptopurine are sometimes referred to as “steroid-sparing” medications because they can also help decrease the need for the long-term use of steroids. They can also help you stay in remission.

Common side effects of azathioprine and mercaptopurine include diarrhea, nausea, and tiredness. But more serious effects are possible, especially with higher doses. Your healthcare provider will prescribe the lowest dose possible. Severe side effects include liver problems, low blood counts, and cancer (though this is rare).

5. Methotrexate

Medications like methotrexate (Trexall, others) that reduce the activity of your immune system are commonly used for autoimmune conditions.

However, oral methotrexate isn’t a common treatment for Crohn’s disease. Most studies show it’s not very effective. Injectable methotrexate forms are more commonly used for Crohn’s, usually in combination with another medication. Mouth sores, liver problems, and lung problems can all pose an issue when taking methotrexate.

6. Rinvoq

Rinvoq (upadacitinib) is the first FDA-approved oral treatment for moderately to severely active Crohn’s disease. This Janus kinase (JAK) inhibitor works by blocking JAK enzymes (proteins) that contribute to inflammation.

This oral tablet may be an option for you if you haven’t had a good response to TNF blocker medications. Humira (adalimumab), an injectable biologic medication, is one popular TNF blocker.

The recommended initial Rinvoq dosage in adults is 45 mg once daily for 12 weeks (3 months). After 12 weeks, you usually drop down to a maintenance dosage of 15 mg once daily. But some people may need 30 mg once daily to manage their Crohn’s. 

Some of the most common Rinvoq side effects are acne, fever, and anemia. Common colds and headaches also bother some people. In some cases, Rinvoq has been linked to more serious health issues. It has boxed warnings, the FDA’s most serious type of warning, for serious infections and cancer. This is also the case for heart-related health issues such as heart attack, stroke, and blood clots.

7. Antibiotics like metronidazole

Antibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro) can treat complications of Crohn’s disease, such as fistulas and abscesses. An abscess is a painful, inflamed, pus-filled area caused by infection. A fistula is an abnormal pathway between two organs or between an organ and the outside of the body. Metronidazole can also help prevent the recurrence of Crohn’s disease after surgery.

However, oral antibiotics such as these aren’t a routine treatment. They’re typically only used when these situations pop up.

8. OTC medications

In some cases, OTC medications can help relieve symptoms of Crohn’s disease. They’re taken on an as-needed basis — not a routine basis. This includes pain relievers such as Tylenol (acetaminophen), anti-diarrhea drugs such as Imodium A-D (loperamide), and anti-gas treatments such as Gas-X (simethicone). 

These aren’t the only OTC options at your disposal. Be sure to talk to your healthcare provider about OTC medications you can take. They can tell you which medications are appropriate to try. And reach back out again if your symptoms worsen or don’t get better in a few days.

How do I know which Crohn’s disease medication is right for me?

There’s no one best Crohn’s disease medication. The best treatment(s) for you depends on many factors, including:

• The location and severity of your GI inflammation

• How your symptoms are affecting your day-to-day life 

• How you responded to Crohn’s medications in the past

• Your risk for medication side effects

• Whether you have a fistula or other intestinal changes

• What options are affordable or covered by your insurance  

You and your healthcare provider can work together to find a Crohn’s disease medication that’s right for you. Keep in mind that it sometimes takes some trial-and-error to find the most helpful treatment.

How to save on Crohn’s disease medications

There are ways to save on your Crohn’s disease medication(s). GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You can find Crohn’s disease medication prices as low as $12 with a free GoodRx discount.

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Written by:

Tanya Kertsman, PharmD

Tanya Kertsman has been a licensed pharmacist in New Jersey and Pennsylvania for 13 years. She has worked in the pharmaceutical industry in medical affairs for 7 years, developing and reviewing medical content for consumers and healthcare professionals.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

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