3. Proton Pump Inhibitors (PPIs)
These medications, including esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec), can be helpful for managing acid reflux. But some studies link PPI use to greater IBD severity and lower remission rates. So it’s often recommended that people with Crohn’s or UC avoid using them long-term.
If you’re struggling with acid reflux, let your gastroenterologist know. They may start by recommending lifestyle changes or a histamine 2 (H2) blocker like famotidine (Pepcid) or ranitidine (Zantac), Dr. Able says.
If those options don’t give you the relief you need, you can talk about ways to use a PPI as safely as possible. “We may prescribe one for short-term use. It’s important to use the lowest dose with maximum effect,” says Stonier.
4. Antidiarrheal Meds
Antidiarrheals like loperamide (Imodium) slow down your bowel movements and make them firmer. But they’re often not a good choice for people with IBD, especially if you have a stricture or if your diarrhea is caused by an IBD flare. “I always recommend my patients ask me before using them,” says Able.
That’s because these medications can raise the risk for a severe complication called toxic megacolon, where the colon fills with gas and ruptures, causing bacteria from the colon to spill into the bloodstream.
If you’re having trouble with urgency or loose stools, let your gastroenterologist know. Together you can decide if an antidiarrheal is appropriate for you, and if so, how much to take.
5. Laxatives
If you’re struggling with constipation — which can happen for many people with IBD — the right laxative may be an option to get things moving again. But it’s important to talk with your gastroenterologist first, since certain types may be better than others. Laxatives also aren’t safe if you have a stricture. “Knowing a patient’s anatomy and disease state helps us work together on a plan for laxatives,” Able says.
If you don’t have a stricture, your doctor may recommend starting with lifestyle changes (like drinking more water or eating more fiber) or trying a fiber supplement like psyllium, which makes stools softer and bulkier so they can pass more easily. If that doesn’t help, they may recommend an osmotic laxative like polyethylene glycol (Miralax). Just keep in mind that both can sometimes cause or worsen symptoms you may already be experiencing, like gas or cramping.
6. GLP-1s
Glucagon-like peptide-1 (GLP-1) receptor agonist medications like semaglutide (Ozempic, Wegovy), and tirzepatide (Mounjaro, Zepbound) are generally considered safe for people with IBD. But since they’re known for causing side effects like nausea, diarrhea, and constipation, it’s possible that a diabetes or weight loss drug could add to symptoms that you may already be dealing with.
Another important thing to keep in mind: Since GLP-1s suppress your appetite, they could make you more prone to nutrient deficiencies — which is already a risk when you have Crohn’s or UC. “With any patient on these meds, careful nutritional goals and practices should be followed to avoid malnourishment due to rapid weight loss,” Able says.
7. Opioid Pain Relievers
Opioid pain relievers are generally only recommended for people with severe pain that can’t be treated with other medicines. That’s especially true for people with IBD, as they can lead to severe digestive issues. “Our IBD guidelines and clinical practices strongly discourage opioid use in IBD patients due to concerns for worsening inflammation, bowel obstruction, and increased risk for infection and mortality,” says Stonier.
If you’re struggling with chronic pain, let your doctor know so you can discuss your options. Pain that’s related to your Crohn’s or UC in particular could be a sign that your IBD isn’t well-controlled, Stonier says. In that case, you and your gastroenterologist can talk about making changes to your treatment plan.
8. Magnesium Supplements
Magnesium isn’t a medication; it’s a supplement that many use to improve sleep, manage fatigue, and ease muscle cramps. Unfortunately, it also has the potential to irritate your GI tract and worsen IBD symptoms that you might already be dealing with, like loose stools or diarrhea.
Paying attention to the type of magnesium can lower the likelihood that this will happen to you. Forms like magnesium glycinate are generally considered to be gentler on the digestive tract than magnesium citrate or magnesium oxide, which can increase diarrhea if an individual has looser stools due to IBD, says Able. Always check with your doctor before adding a new supplement to your routine.
