IBD Notable ADRs

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Last updated 4:12 AM on 8/31/26
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18 Terms

1
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Hypersensitivity reactions

  • [All 5-ASAs:]

  • Sulfasalazine, olasalazine, balsalazide, mesalamine 


  • Infliximab (anti-TNF)

    • Within 2 hours of taking

  • [All JAK/STAT inhibitors:]

  • Ustekinumab, tofacitinib, upadacitinib


  • Mirikizumab (IL-23 antagonist)

    • Severe; anaphylaxis  

  • Guselkumab (IL-23 antagonist)

    • Rash


2
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Severe infections (BBW)

  • [All anti-TNFs:]

  • Adalimumab, golimumab, infliximab, certolizumab pegol


  • Tofacitinib (JAK/STAT inhibitor)


  • Cyclosporine 

    • When used with other immunosuppressive drugs


  • (Note: Vedolizumab – the integrin inhibitor – has risk of developing serious infections, but not a BBW; less of a risk than with these)


3
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Malignancy (BBW)

  • [All anti-TNFs:]

  • Adalimumab, golimumab, infliximab, certolizumab pegol

  • Tofacitinib (JAK/STAT inhibitor)


  • Azathioprine


  • Cyclosporine

    • When used with other immunosuppressive drugs


4
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Thrombosis and CV events (BBW)

  • Tofacitinib (JAK/STAT inhibitor)


5
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Avoid live vaccines

TLDR: all of them except the four 5-ASAs, budesonide, azathioprine

6
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Test for TB (active and latent) prior to initiation

TLDR: all of them except 5-ASAs, budesonide, S1Ps, azathioprine, and cyclosporine

7
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Test for HepB prior to initiation

  • [All anti-TNFs:]

  • Adalimumab, golimumab, infliximab, certolizumab


  • Methotrexate


8
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Recommend recombinant herpes zoster vaccine before starting

  • [All JAK/STAT inhibitors:]

  • Ustekinumab, tofacitinib, upadacitinib


  • Note: mirikizumab – a IL-23 antagonist – has herpes virus infection as an ADR, but not a pretreatment requirement


9
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PML risk

  • [All integrin inhibitors:]

  • Vedolizumab – there’s just the one


  • Azathioprine


  • Cyclosporine


10
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CI with sulfite sensitivity

  • [All 5-ASAs:]

  • Sulfasalazine, olasalazine, balsalazide, mesalamine


11
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CI with sulfonamide hypersensitivity

  • [All 5-ASAs:]

  • Sulfasalazine, lasalazine, balsalazide, mesalamine


12
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Cushing’s syndrome

Budesonide

13
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Elevated cholesterol

  • [All JAK/STAT inhibitors:]

  • Ustekinumab, tofacitinib, upadacitinib


14
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Photosensitivity

Methotrexate

15
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Myelosuppression

Methotrexate

16
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Leukopenia

Methotrexate

17
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Pancytopenia

Methotrexate

18
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Limit K+ sparing diuretics

Cyclosporin