Category: Treatment

Orodispersible Budesonide (Jorveza)

Jorveza is a medicine used to treat adults with eosinophilic oesophagitis. Eosinophilic oesophagitis is inflammation of the oesophagus (the passage that leads from the mouth to the stomach), which causes symptoms such as dysphagia (difficulty swallowing) and blockage of the oesophagus. It is caused by a large build-up of white blood cells called eosinophils in the lining of the oesophagus.

It is essential to follow the instructions below in order to use this drug correctly:

  1. To take this medication, place a tablet on the tip of your tongue and gently press it against the roof of your mouth until it dissolves. The tablet should dissolve in approximately 2 minutes but may take up to 20 minutes. While the tablet is dissolving, you can swallow the dissolved material in your saliva a little bit at a time but do not chew or swallow the undissolved tablet.
  2. Tablets MUST NOT be chewed or swallowed whole
  3. This medication should be taken at least 30 minutes after a meal and NOT with liquid or food. 
  4. Avoid brushing your teeth, eating or drinking, or rinsing your mouth for at least 30 minutes after taking the tablet. Do not use any oral solutions, sprays, or chewable tablets for 30 minutes before or after taking this medication.

References

  1. European Medicines Agency – Jorveza 4/26/22
  2. Medbroadcast – Jorveza 4/26/22

Medications used in Crohn’s and Ulcerative Colitis

Below is a list of medications commonly used for Crohn’s and ulcerative colitis with information on their side-effects:

5 ASA (mesalamine, Asacol, Pentasa, Salofalk)

Side-effects: 5 % worsening of colitis, renal failure (< 1/1000)

Metronidazole (Flagyl)

Side-effects: vomiting if take alcohol, nausea, altered taste, dark urine.  Chronic use may result in peripheral neuropathy (permanent)

Prednisone  (steroids)

Side-effects:Risks of longterm use include osteoporosis, cataracts, avascular necrosis (< 1 in 10,000 but may need hip or knee replacement).  Click here to use FRAX – a tool developed by the World Health Organisation to predict your 10 year risk of a bone fracture.

Azathioprine (Imuran), 6 mercaptopurine

Side-effects: Pancreatitis (3-5%, rarely fatal), liver test abnormalities, lymphoma (1:1000), ongoing risk of bone marrow suppression (if you have a fever for more than 6 hours, do NOT take another pill until your blood count is checked).

A recent publication also looked at the risk of non-melanoma skin cancer in patients treated with azathioprine in 14,527 patients with a follow-up of 8.1 years (median).  There was an overall twofold increased risk in developing non-melanoma skin cancer which increased with duration of use.  The rate (per 1000 person-years) was 3.7 for non-users versus 5.8, 7.9, 8.3, 7.8, and 13.6 for the 1st, 2nd, 3rd, 4th, and 5th year of thiopurine use.  Implications of this include the use of sun-protection and consideration of regular (? annual) review by a dermatologist. Another publication confirmed that the risk was 1.85 times baseline (P<0.05).

A prospective cohort study of 19,486 French patients followed for a median of 35 months showed a significantly increased hazard ratio of developing lymphoma of 5.28 (P<0.01).  The rate of lymphoma per 1000 patient years was 0.26 in those who had never received the drug and 0.90 in those who had.  Thus the increased risk was 0.64 per 1000 patient years.  In other words if a person took the drug for 50 years, there would be a 1 in 31 risk of getting lymphoma.