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 thorough baseline and ongoing monitoring prior to and during advanced (biologic or small-molecule) therapy:

  • Screen for infections: TB (IGRA and/or tuberculin skin test + CXR), hepatitis B & C (HBsAg, anti-HBc, anti-HBs, HCV Ab ± PCR), HIV, and varicella immunity (± EBV if relevant).
  • Update vaccinations: Including influenza, pneumococcal, COVID-19, etc., where feasible before immunosuppression.
  • Regular labs: FBC, LFT, and renal function at recommended intervals.
  • Align therapy with disease severity/location and individual comorbidities.
  • Refer to detailed ECCO algorithms for step-up or top-down management approaches.
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: Useful in mild-moderate UC; topical forms especially for left-sided disease.
Thiopurines (Azathioprine, Mercaptopurine)
  • Induction: Not typically used for rapid induction
  • Azathioprine Maintenance: 1.5–2.5 mg/kg/day
  • Mercaptopurine Maintenance: 0.75–1.5 mg/kg/day
  • Monitoring: FBC, LFT; consider TPMT testing first
  • ECCO Note: Watch for myelotoxicity, especially in 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 Standard): Co-prescribe (e.g. 5 mg once weekly), separate day from MTX dose
  • ECCO Note: Consider folate supplementation; watch for liver fibrosis with long-term use.
Anti-TNF Agents (Infliximab, Adalimumab, etc.)
  • Infliximab (IV): 5 mg/kg at 0, 2, 6 weeks, then every 8 weeks
  • Adalimumab (SC): Induction 160/80 mg at 0,2 weeks, then 40 mg every 2 weeks
  • Monitoring: Reinforce standard infection screening and immunization update
  • ECCO Note: Combine with immunomodulators to reduce immunogenicity; watch for infection risk.
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, etc.; assess response by week 14
  • ECCO Note: Gut-selective; used for moderate-severe Crohn’s or UC after other therapies.
IL-12/23 & IL-23 Inhibitors (Ustekinumab, Risankizumab, Mirikizumab, etc.)
  • Ustekinumab: IV induction (dose by weight), 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: IL-23 p19 inhibitor approved for moderate-severe UC dose suggestion for induction for Week 0,4,8 300mg for UC , 900mg for CD Mantinence dose starting from week 12- every 4 weeks 200mg for UC & 300mg for CD
  • Monitoring: CBC, LFT, TB screening; general infection screening
  • ECCO Note: Effective for moderate-severe disease; can be an alternative after anti-TNF failure.
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 for infection risk (especially herpes zoster)
  • ECCO Note: Rapid onset but check for cardiovascular, thrombotic risk factors.
S1P Receptor Modulators (Ozanimod, Etrasimod)
  • Ozanimod: Titrate from 0.23 mg, 0.46 mg, then 0.92 mg daily
  • Etrasimod: 2 mg daily
  • Monitoring: Heart rate, ECG, LFT
  • ECCO Note: Reduces lymphocyte trafficking; screen for cardiac conduction issues.

References

Original resource at: ibd-eii.com/ibdcheatsheet
DOI reference: 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.