Australian IBD medications

If your child has been diagnosed with Crohn’s disease or ulcerative colitis (IBD), you may quickly find yourself learning about medicines you have never heard of before.

There are several different types of IBD medications available in Australia, and the medicine your child needs will depend on their age, type of IBD, symptoms, disease severity and how they respond to treatment.

IBD treatment aims to control inflammation, help your child feel better, achieve remission and reduce the risk of future flares and complications.

💊 What types of IBD medications are used?

There are several groups of medicines that may be used to treat IBD.

These include:

• 5-ASA medicines such as mesalazine

• Corticosteroids

• Immunomodulators such as azathioprine

• Biologic medicines

• Other advanced therapies, including some targeted medicines

• Antibiotics in certain situations

Not every medicine is suitable for every child, and some medicines are used more commonly for Crohn’s disease or ulcerative colitis than others.

🧡 5-ASA medicines

5-ASA medicines, also known as aminosalicylates, are commonly used to treat inflammation, particularly in ulcerative colitis.

One example is mesalazine.

In Australia, mesalazine is available under several brand names, including Pentasa and Salofalk.

Mesalazine can be used to treat active disease and, in some cases, help maintain remission. Pentasa is listed in Australia for the treatment of mild to moderate ulcerative colitis and Crohn’s disease and for maintenance of remission.

These medicines can come in different forms, including tablets, capsules, granules and rectal preparations.

💉 Steroids

Corticosteroids can be used to help bring a flare under control because they can reduce inflammation relatively quickly.

Examples include medicines such as prednisolone and budesonide.

Steroids are generally not intended to be a long-term maintenance treatment because prolonged steroid use can cause significant side effects.

Your child's gastroenterologist will determine whether a steroid is appropriate and how it should be used.

🧪 Immunomodulators

Immunomodulators work by changing or reducing certain immune system activity involved in inflammation.

One example is azathioprine.

These medicines may be used as part of an IBD treatment plan for some children.

Because medicines such as azathioprine affect the immune system, children taking them may need regular blood tests and monitoring.

Your child's IBD team will explain what monitoring is required and what symptoms you should look out for.

🧬 Biologic medicines

Biologic medicines are advanced medicines that target specific parts of the immune system involved in inflammation.

They may be used when IBD is moderate to severe, when other treatments have not worked well enough, or when a child needs a different approach to controlling their disease.

Biologic medicines used in IBD can include medicines that target specific inflammatory pathways, such as tumour necrosis factor or other immune pathways.

Some are given by infusion into a vein, while others are given as an injection under the skin.

The choice of biologic depends on your child's individual circumstances and their gastroenterologist's treatment plan.

🏥 What are biologics like in Australia?

For some children, biologic treatment is provided through a hospital or specialist IBD service.

Depending on the medicine and treatment plan, your child may receive their medication through an infusion at hospital or learn how to have an injection at home.

Some biologic medicines are subsidised through the Pharmaceutical Benefits Scheme (PBS) when specific eligibility requirements are met.

PBS restrictions can apply, so the fact that a medicine exists in Australia does not necessarily mean every patient can automatically receive it through the PBS.

Your child's gastroenterology team or hospital pharmacy can explain whether your child's particular medicine is PBS-subsidised and what criteria apply.

💰 What is the PBS?

The Pharmaceutical Benefits Scheme (PBS) helps make many prescription medicines more affordable for eligible Australians.

Some IBD medicines are available through the PBS.

For example, current Australian medicine information confirms that both Pentasa (mesalazine) and Salofalk (mesalazine) have PBS listings.

However, PBS availability can depend on the particular medicine, strength, formulation and clinical circumstances.

A medicine being available in Australia does not always mean it is automatically subsidised for every person or every use.

🧾 Why does my child's doctor mention PBS criteria?

Some medicines have specific PBS requirements.

This means your child's doctor may need to confirm that your child meets particular criteria before the medicine can be supplied under the PBS.

For advanced IBD treatments, this can involve things such as:

• The type of IBD

• How severe the disease is

• Previous treatments

• Whether previous treatments have worked

• Whether the child has lost response to another medicine

• Age or other eligibility requirements

Your gastroenterologist can explain the criteria that apply to your child's particular medicine.

💳 How much do IBD medications cost?

The cost of IBD medication can vary significantly.

If a medicine is supplied through the PBS and your child is eligible, you generally pay the applicable PBS patient contribution rather than the full price of the medicine.

Some medicines may not be PBS-subsidised for your child's particular situation, and private prescriptions can cost considerably more.

There may also be differences between medicines supplied through a hospital and those collected from a community pharmacy.

It is always worth asking:

"Is this medicine PBS-subsidised for my child?"

and

"How much will we have to pay?"

🏪 Where do you get IBD medications?

Where you collect your child's medication will depend on the medicine.

Some medicines can be collected from a community pharmacy with a prescription.

Other medicines, particularly some biologic treatments, may be supplied through a hospital pharmacy or administered at a hospital or specialist infusion centre.

Your IBD team should tell you where your child's medication needs to be collected or administered.

📅 What happens if we run out of medication?

Try not to wait until the last dose before organising a repeat prescription.

Some IBD medications need to be ordered by the pharmacy, while hospital medications may require coordination with your IBD team.

Keeping track of when your child's medication is running low can help prevent missed doses.

If you are going away, travelling or moving between cities, speak with your child's healthcare team or pharmacist beforehand so you can make a plan for getting enough medication.

🧒 Can children take the same IBD medications as adults?

Children can use many of the same types of IBD medications as adults, but doses, formulations and approved uses can differ.

Paediatric IBD treatment needs to take into account things such as:

• Age

• Weight

• Growth

• Puberty

• Disease location and severity

• Other medications

• Previous treatment

• Blood test results

Some medicines may also have age-specific approvals or PBS requirements.

Your child's paediatric gastroenterologist will choose treatment based on your child's individual needs.

🔄 What happens if a medication stops working?

Unfortunately, IBD medications do not work perfectly for everyone.

Sometimes a medicine may never control the inflammation adequately. In other cases, it may work well for a while and then become less effective.

If your child develops symptoms again, their IBD team may investigate whether they are having a flare and whether the medicine is still working.

This may involve blood tests, stool tests such as faecal calprotectin, imaging, endoscopy or other investigations.

The treatment may then be adjusted if necessary.

⚠️ What about side effects?

All medicines can have side effects.

The possible side effects depend on the medication your child is taking.

Some medicines require specific monitoring, such as regular blood tests.

Make sure you know:

• What your child's medication is called

• Why they are taking it

• How much they should take

• When they should take it

• What side effects to look out for

• Which symptoms require urgent medical attention

• What monitoring is required

• Who to contact if you have concerns

Never stop or change your child's IBD medication without speaking with their healthcare team first.

📋 Keep a medication list

Having an up-to-date medication list can be incredibly useful.

Keep a record of:

Medication:

Dose:

How often:

Why they take it:

When they started:

Prescribing doctor:

Pharmacy:

Next prescription due:

You can also keep a copy on your phone so you have it with you during hospital visits, appointments and emergencies.

Where can you find reliable information?

Medication information can change, so it is important to use reliable Australian sources.

You can check medicine information through Healthdirect, the Therapeutic Goods Administration (TGA) and the Pharmaceutical Benefits Scheme (PBS).

Your child's gastroenterologist, IBD nurse and pharmacist can also explain how a particular medication is used and supplied in Australia.

❤️ Remember

IBD medications can feel overwhelming at first.

You may hear names such as mesalazine, azathioprine, steroids, biologics and other advanced therapies and wonder how you are supposed to remember what they all do.

You don't need to learn everything at once.

Your child's IBD team should explain why a medication has been recommended, how it is given, what monitoring is needed and what to do if you have concerns.

Never change, stop or restart an IBD medication without speaking with your child's doctor or IBD team.