Diarrhoea can be treated with loperamide or codeine phosphate, but this should be under specialist advice in IBD as there an increased risk of toxic megacolon. For that reason, antidiarrhoeals are contraindicated in acute ulcerative colitis. Colestyramine is licensed for the relief of diarrhoea associated with Crohn's disease.15
Immunosuppressants and biologicals can increase the risk of infections, so annual flu vaccinations and a pneumococcal vaccination are recommended in Crohn’s. However, live vaccines such as the MMR vaccine should be avoided.9
IBD may impair fertility, with the chances of pregnancy falling during flare-ups. Treatments may also temporarily suppress sperm count or reduce the effectiveness of oral contraceptives. Some medicines may also be harmful to the foetus.
Some medication can aggravate the bowel or can interact and suppress drugs being used to treat IBD. Antibiotics, non-steroidal anti-inflammatory drugs, isotretinoin, oral contraceptives, and biologic medicines such as etanercept, ipilimumab, and rituximab are among those linked to causing or worsening IBD.9,18