What you need to know

Interactive IBD Drugs Cheat Sheet

This section reflects ECCO guidance and common clinical practice adopted with permission from Dr B Gros. Always confirm specifics with local guidelines. This summary is not a replacement for the comprehensive ECCO/BSG guidelines.

General ECCO‑Based Recommendations & Monitoring

ECCO guidelines emphasize baseline and ongoing checks before and during advanced therapy:

  • Screen for infections: TB (IGRA or skin test + CXR), hepatitis B/C, HIV, varicella (± EBV if relevant).
  • Update vaccinations: Influenza, pneumococcal, COVID‑19, and others before immunosuppression.
  • Regular labs: FBC, LFT, renal function at set intervals.
  • Match therapy to disease severity/location and your patient’s comorbidities.
  • Use ECCO algorithms for step‑up or top‑down decisions.
5‑ASA (Mesalazine) Agents
  • Induction Dose: ≥ 2 g/day up to 4.8 g/day
  • Maintenance Dose: ≥ 2 g/day
  • Route: Oral or topical
  • Monitoring: Renal function checks
  • ECCO Note: Best for mild–moderate UC; topical for left‑sided disease.
Thiopurines (Azathioprine, Mercaptopurine)
  • Induction: Not for rapid induction
  • Azathioprine Maintenance: 1.5–2.5 mg/kg/day
  • Mercaptopurine Maintenance: 0.75–1.5 mg/kg/day
  • Monitoring: FBC, LFT; TPMT testing first
  • ECCO Note: Watch for myelotoxicity, especially with combination therapy.
Methotrexate
  • Induction: 25 mg IM weekly (rarely alone for rapid induction)
  • Maintenance: 15 mg IM weekly
  • Monitoring: CBC, LFT, renal function
  • Folic Acid (UK): 5 mg once weekly, on a different day
  • ECCO Note: Supplement folate; monitor for liver fibrosis.
Anti‑TNF Agents (Infliximab, Adalimumab, etc.)
  • Infliximab (IV): 5 mg/kg at 0, 2, 6 weeks, then every 8 weeks
  • Adalimumab (SC): 160/80 mg at 0, 2 weeks, then 40 mg every 2 weeks
  • Monitoring: Standard infection screening and vaccine update
  • ECCO Note: Combine with immunomodulators to cut immunogenicity; infection risk rises.
  • Cost (Sunderland 2025): Adalimumab 40 mg pen £50; Infliximab 120 mg pen £268
Anti‑Integrin (Vedolizumab)
  • Vedolizumab IV: 300 mg at 0, 2, 6 weeks, then every 8 weeks
  • Vedolizumab SC: 108 mg every 2 weeks
  • Monitoring: TB, viral hepatitis, HIV; check response by week 14
  • ECCO Note: Gut‑selective; for moderate–severe UC or CD after other therapy.
IL‑12/23 & IL‑23 Inhibitors (Ustekinumab, Risankizumab, Mirikizumab, etc.)
  • Ustekinumab: IV induction (weight‑based), then SC 90 mg every 8–12 weeks
  • Risankizumab: IV 600 mg at 0, 4, 8 weeks (Crohn’s), then SC 360 mg every 8 weeks
  • Mirikizumab: 300 mg IV at 0, 4, 8 weeks (UC; 900 mg for CD), then from week 12 SC 200 mg (UC) or 300 mg (CD) every 4 weeks
  • Monitoring: CBC, LFT, TB screen; infection checks
  • ECCO Note: Works in moderate–severe disease; option after anti‑TNF failure.
  • Cost (Sunderland 2025): Ustekinumab 130 mg vial £360.70; Mirikizumab 300 mg vial £692
JAK Inhibitors (Tofacitinib, Filgotinib, Upadacitinib)
  • Tofacitinib: 10 mg BD induction, 5 mg BD maintenance
  • Filgotinib: 200 mg daily
  • Upadacitinib: 45 mg daily induction, then 15–30 mg daily maintenance
  • Monitoring: Lipids, FBC, LFT; watch infection risk (herpes zoster)
  • ECCO Note: Rapid onset; check CV and thrombotic risks.
  • Cost (Sunderland 2025): Tofacitinib 5 mg × 56 £366.75; Tofacitinib 10 mg × 56 £733.50; Upadacitinib 45 mg × 28 £873.93
S1P Receptor Modulators (Ozanimod, Etrasimod)
  • Ozanimod: Titrate 0.23 mg → 0.46 mg → 0.92 mg daily
  • Etrasimod: 2 mg daily
  • Monitoring: Heart rate, ECG, LFT
  • ECCO Note: Reduces lymphocyte trafficking; screen cardiac conduction.

References

Resource: ibd-eii.com/ibdcheatsheet
DOI: 10.5281/zenodo.13624693


UK Acute Upper GI Bleeding bundle https://www.bsg.org.uk/wp-content/uploads/2019/12/Fig-1-Summary-AUGIB-care-bundle.pdf

BSG Decompensated Cirrhosis Care Bundle video https://www.bsg.org.uk/clinical-resource/bsg-decompensated-cirrhosis-care-bundle/


Gastroenterology/Nutrition

BSG Investigation of Chronic Diarrhoea in adults:
https://www.bsg.org.uk/clinical-resource/guidelines-for-the-investigation-of-chronic-diarrhoea-in-adults-bsg-3rd-edition/

NICE guidance on Ulcerative Colitis https://www.nice.org.uk/guidance/ng130

A practical approach to the management of high-output stoma https://fg.bmj.com/content/5/3/203

BSG Handbook

For new patients admitted with suspected IBD (Crohns or UC)

Acute IBD checklistsDownload

GI Bleeds
Blood Tests: Daily FBC, U+E every other day for 5 days or until no bleeding.
Monitoring: Stool charts for all patients.
 
Acute Colitis
Stool Tests: Send for cultures, C. difficile toxin, and maintain stool charts.
Bloods: FBC, U+E, LFTs, CRP daily. Include Mg, Ca, and PO4 if major nutritional issues. For new patients pre biologic screen including TPMT.
Imaging: Erect CXR and AXR as needed to exclude toxic dilatation (consult SpR for frequency).
 
Refeeding Syndrome
Monitoring: Daily U+E, Ca, PO4, and Mg until stable.
Parenteral Nutrition: Daily monitoring (FBC, U+E, Mg, Ca, PO4, LFTs, CRP) if unstable, twice weekly once stable.

Commonly used drugs in gastroenterology reference guide (not for clinical use, please cross reference.)- by Dr Ben McCleod. 

Gastroenterology Medications Download file

Post-ERCP
Monitoring: If pain-free and NEWS normal, no bloods required. If in pain, perform FBC, U+E, LFT, CRP, and amylase. Consider urgent CT (perforation) and surgical review.
 
Post-EUS/Other Therapies
If pain-free and mobilizing, no bloods required. If in pain or NEWS abnormal, manage like post-ERCP (omit amylase).
 
Gastroscopy/OGD
Fasting: Minimum 4 hours, ideally nil by mouth from midnight for morning lists or light breakfast for afternoon lists.
Urgency: Urgent requests should be delivered directly to the endoscopy unit and discussed with the endoscopy sister/nurse in charge.
Consent: Completed by the scoping clinician in the endoscopy department.
 
Colonoscopy
Bowel Prep: Moviprep (specific timing depending on morning/afternoon list). Stop ferrous sulfate 1-2 weeks before.
Antiplatelets/Anticoagulants: Check with seniors about stopping these drugs before the procedure if therapeutic interventions (e.g., polypectomy) are planned.
 
ERCP/EUS
Fasting: As per OGD guidelines.
Bloods: FBC, U+E, LFTs, clotting, and Group and Save.
Consent: Taken by SpR or consultant.
Antiplatelets/Anticoagulants: Stop 7 days before (except aspirin).
 
Intestinal Failure Patients
Key Notes: Do not handle central lines; only trained staff manage them to avoid infections.
Bloods on Admission: FBC, U+E, LFT, clotting, CRP, Mg, bone profile, B12, folate, and Vitamin D.
Monitoring: Fluid balance, electrolyte levels, and nutritional status. Address high stoma outputs with TPN adjustments, fluid restriction, and medications (e.g., loperamide, codeine, PPIs).
 
Liver Procedures
Bloods: FBC, U+E, LFTs, clotting, Group and Save.
Consent: Registrar or consultant only.
Pre-Procedure Management: Confirm antiplatelets/anticoagulants are stopped. Vitamin K, platelets, or FFP may be needed for coagulation support.


Specific Procedures:
Liver Biopsy: Consider plugged or transjugular biopsy if clotting is abnormal.
TACE/TIPSS: Requires antibiotics pre- and post-procedure, adequate hydration, and coagulation correction if needed.