Trellus Health

Glossary of Medication Monitoring

This Glossary highlights the recommended monitoring for certain IBD Medications as part of standard of
care. It is important that you review these recommendations with your GI Provider.

Updated 01/08/24

IBD Medication
Common Brands
Recommended Safety Checks

aminosalicylates –balsalazide, mesalamine

Apriso™

Asacol® HD

Colazal®

Giazo™

Canasa®

Delzicol™

Rowasa®

Lialda™

Pentasa®

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood counts, renal function, liver function.

While on Therapy

  • Complete yearly Renal (kidney) function test often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP).
  • Complete yearly urinalysis.

aminosalicylates – sulfasalazine

Azulfidine®

Azulfidine® EN-tabs

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Complete yearly urinalysis.
  • Take daily folic acid supplements (1mg /day and up 2 mg/day if pregnant).

NOTE: More frequent lab monitoring may be necessary during first few months of therapy.

biologics – TNF-α (adalimumab, infliximab, certolizumab pegol, golimumab)

Humira®

Cyltezo™

Amjevita®

Hyrimoz™

Cimzia®

Simponi®

Remicade®

Renflexis®

Avsola

Inflectra™

IXIFI™

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Check Hepatitis B Immunity Status (preferably before starting therapy but can be done after starting therapy) and re/vaccinate if not immune.
  • Avoid live vaccines within 4 weeks of starting therapy and during therapy
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete annual TB risk assessment and screening if meeting criteria for high risk.
  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic. (This can be considered shorty after starting therapy).
Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

biologics – α4 integrin (natalizumab)

Tysabri®

Prior to Initiating Therapy

  • Enroll in TOUCH program.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.

biologics – IL-12/23 (ustekinumab)

IL-23 (risankizumab, mirikizumab)

Stelara®

Skyrizi®

Omvoh®

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Avoid live vaccines within 4 weeks of starting therapy.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete annual TB risk assessment and screening if meeting criteria for high risk.
  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months. For Skyrizi, liver function monitoring is recommended within the first 3 months of initiating therapy, and up to 6 months for Omvoh.
    .
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic.
Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

biologics – α4β7 integrin (vedolizumab)

Entyvio®

Prior to Initiating Therapy

  • Optional: Patients at high risk for tuberculosis (TB) may be screened for TB, at discretion of the provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Avoid live vaccines within 4 weeks of starting therapy.

While on Therapy

  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic.

corticosteroids – budesonide

Entocort® EC

Uceris™

  • Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended.
  • Consider an ophthalmology exam to monitor for ocular side effects.
  • Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary.

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

corticosteroids – prednisone

A-Methapred®
Depo-Medrol®
Medrol Dosepak®
Solu-Medrol®
Deltasone®
Oraped®
Prelone®
Pediapred®

  • Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended.
  • Consider an ophthalmology exam to monitor for ocular side effects.
  • Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary.

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

immunosuppressant – cyclosporine

Neoral®

Sandimmune®

Gengraf®

Prior to Initiating Therapy

  • Review all medications, including herbal supplements, with provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels.

While on Therapy

  • Avoid grapefruit juice.
  • Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol and magnesium levels every 3-6 months.
  • Ensure consistency of taking medication, either always with food or always without food.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

immunosuppressant – methotrexate

Rheumatrex®

MTX®

Mexate®

Trexall®

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Take daily folic acid supplements (1 mg/day).

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.

immunosuppressant – tacrolimus

Prograf®

Astagraf XL®

Envarsus® XR

Hecoria®

Prior to Initiating Therapy

  • Review all medications, including herbal supplements, with provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels.

While on Therapy

  • Avoid grapefruit juice.
  • Ensure consistency of taking medication, either always with food or always without food.
  • Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels every 3-6 months.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider

immunosuppressant – thiopurine, azathioprine, 6-Mercaptopurine (6-MP)

Imuran®

Azasan®

Purinethol®

Purixan

Prior to Initiating Therapy

  • Complete Thiopurine methyltransferase (TPMT) enzyme blood test to ensure a safe start to the medication. Results can impact starting dose.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system (Thiopurine Metabolites).

NOTE: White blood cell counts should be monitored more often in the first 3 months of therapy.

small molecules – JAK-inhibitor (tofacitinib, upadacitinib)

Xeljanz®

Rinvoq®

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Avoid live vaccines within 4 weeks of starting therapy and during therapy.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Consider the Inactive Herpes Zoster vaccine (Shingrix) especially if you are above the age of 50. Please discuss with your GI provider and primary care provider.

While on Therapy

  • Complete a Fasting Lipid Profile, recommended 4-8 weeks after starting therapy.
  • Complete annual TB risk assessment and screening if you meet criteria for high risk.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list.
Considering Pregnancy? Your GI provider may need to adjust your IBD care plan, so please include your GI provider in discussions when family-planning.

small molecules – S1P Receptor Molecules (ozanimod, etrasimod)

Zeposia®

Velsipity®

Prior to Initiating Therapy

  • Complete an Electrocardiogram (EKG) to screen for preexisting heart rhythm abnormalities.
  • Complete blood pressure monitoring
  • Review all your medications with your provider to ensure they don’t impact your heart rate.
  • Visit an ophthalmologist prior to or near the start of treatment especially if you have diabetes or if you are diagnosed with inflammation or swelling inside your eye.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Consider the Inactive Herpes Zoster vaccine (Shingrix), especially if above the age of 50. Please discuss with your GI provider and primary care provider.
  • Skin checks are recommended prior to or near the start of treatment.

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Skin and eye examinations are recommended periodically while on therapy.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.

IBD Medication

aminosalicylates –balsalazide, mesalamine

Common Brands

Apriso™

Asacol® HD

Colazal®

Giazo™

Canasa®

Delzicol™

Rowasa®

Lialda™

Pentasa®

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood counts, renal function, liver function.

While on Therapy

  • Complete yearly Renal (kidney) function test often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP).
  • Complete yearly urinalysis.

IBD Medication

aminosalicylates – sulfasalazine

Common Brands

Azulfidine®

Azulfidine® EN-tabs

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Complete yearly urinalysis.
  • Take daily folic acid supplements (1mg /day and up 2 mg/day if pregnant).

NOTE: More frequent lab monitoring may be necessary during first few months of therapy.

IBD Medication

biologics – TNF-α (adalimumab, infliximab, certolizumab pegol, golimumab)

Common Brands

Humira®

Cyltezo™

Amjevita®

Hyrimoz™

Cimzia®

Simponi®

Remicade®

Renflexis®

Avsola

Inflectra™

IXIFI™

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Check Hepatitis B Immunity Status (preferably before starting therapy but can be done after starting therapy) and re/vaccinate if not immune.
  • Avoid live vaccines within 4 weeks of starting therapy and during therapy
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete annual TB risk assessment and screening if meeting criteria for high risk.
  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic. (This can be considered shorty after starting therapy).
Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

IBD Medication

biologics – α4 integrin (natalizumab)

Common Brands

Tysabri®

Recommended Safety Checks

Prior to Initiating Therapy

  • Enroll in TOUCH program.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.

IBD Medication

biologics – IL-12/23 (ustekinumab)

IL-23 (risankizumab, mirikizumab)

Common Brands

Stelara®

Skyrizi®

Omvoh®

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Avoid live vaccines within 4 weeks of starting therapy.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete annual TB risk assessment and screening if meeting criteria for high risk.
  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months. For Skyrizi, liver function monitoring is recommended within the first 3 months of initiating therapy, and up to 6 months for Omvoh.
    .
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic.
Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

IBD Medication

biologics – α4β7 integrin (vedolizumab)

Common Brands

Entyvio®

Recommended Safety Checks

Prior to Initiating Therapy

  • Optional: Patients at high risk for tuberculosis (TB) may be screened for TB, at discretion of the provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Avoid live vaccines within 4 weeks of starting therapy.

While on Therapy

  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic.

IBD Medication

corticosteroids – budesonide

Common Brands

Entocort® EC

Uceris™

Recommended Safety Checks

  • Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended.
  • Consider an ophthalmology exam to monitor for ocular side effects.
  • Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary.

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

IBD Medication

corticosteroids – prednisone

Common Brands

A-Methapred®
Depo-Medrol®
Medrol Dosepak®
Solu-Medrol®
Deltasone®
Oraped®
Prelone®
Pediapred®

Recommended Safety Checks

  • Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended.
  • Consider an ophthalmology exam to monitor for ocular side effects.
  • Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary.

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

IBD Medication

immunosuppressant – cyclosporine

Common Brands

Neoral®

Sandimmune®

Gengraf®

Recommended Safety Checks

Prior to Initiating Therapy

  • Review all medications, including herbal supplements, with provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels.

While on Therapy

  • Avoid grapefruit juice.
  • Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol and magnesium levels every 3-6 months.
  • Ensure consistency of taking medication, either always with food or always without food.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

IBD Medication

immunosuppressant – methotrexate

Common Brands

Rheumatrex®

MTX®

Mexate®

Trexall®

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Take daily folic acid supplements (1 mg/day).

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.

IBD Medication

immunosuppressant – tacrolimus

Common Brands

Prograf®

Astagraf XL®

Envarsus® XR

Hecoria®

Recommended Safety Checks

Prior to Initiating Therapy

  • Review all medications, including herbal supplements, with provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels.

While on Therapy

  • Avoid grapefruit juice.
  • Ensure consistency of taking medication, either always with food or always without food.
  • Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels every 3-6 months.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider

IBD Medication

immunosuppressant – thiopurine, azathioprine, 6-Mercaptopurine (6-MP)

Common Brands

Imuran®

Azasan®

Purinethol®

Purixan

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete Thiopurine methyltransferase (TPMT) enzyme blood test to ensure a safe start to the medication. Results can impact starting dose.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system (Thiopurine Metabolites).

NOTE: White blood cell counts should be monitored more often in the first 3 months of therapy.

IBD Medication

small molecules – JAK-inhibitor (tofacitinib, upadacitinib)

Common Brands

Xeljanz®

Rinvoq®

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Avoid live vaccines within 4 weeks of starting therapy and during therapy.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Consider the Inactive Herpes Zoster vaccine (Shingrix) especially if you are above the age of 50. Please discuss with your GI provider and primary care provider.

While on Therapy

  • Complete a Fasting Lipid Profile, recommended 4-8 weeks after starting therapy.
  • Complete annual TB risk assessment and screening if you meet criteria for high risk.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list.
Considering Pregnancy? Your GI provider may need to adjust your IBD care plan, so please include your GI provider in discussions when family-planning.

IBD Medication

small molecules – S1P Receptor Molecules (ozanimod, etrasimod)

Common Brands

Zeposia®

Velsipity®

Recommended Safety Checks

Prior to Initiating Therapy

  • Complete an Electrocardiogram (EKG) to screen for preexisting heart rhythm abnormalities.
  • Complete blood pressure monitoring
  • Review all your medications with your provider to ensure they don’t impact your heart rate.
  • Visit an ophthalmologist prior to or near the start of treatment especially if you have diabetes or if you are diagnosed with inflammation or swelling inside your eye.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Consider the Inactive Herpes Zoster vaccine (Shingrix), especially if above the age of 50. Please discuss with your GI provider and primary care provider.
  • Skin checks are recommended prior to or near the start of treatment.

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Skin and eye examinations are recommended periodically while on therapy.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.
IBD Medication Common Brands Recommended Safety Checks

aminosalicylates –balsalazide, mesalamine

Apriso™

Asacol® HD

Colazal®

Giazo™

Canasa®

Delzicol™

Rowasa®

Lialda™

Pentasa®

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood counts, renal function, liver function.

While on Therapy

  • Complete yearly Renal (kidney) function test often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP).
  • Complete yearly urinalysis.

aminosalicylates – sulfasalazine

Azulfidine®

Azulfidine® EN-tabs

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Complete yearly urinalysis.
  • Take daily folic acid supplements (1mg /day and up 2 mg/day if pregnant).

NOTE: More frequent lab monitoring may be necessary during first few months of therapy.

biologics – TNF-α (adalimumab, infliximab, certolizumab pegol, golimumab)

Humira®

Cyltezo™

Amjevita®

Hyrimoz™

Cimzia®

Simponi®

Remicade®

Renflexis®

Avsola

Inflectra™

IXIFI™

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Check Hepatitis B Immunity Status (preferably before starting therapy but can be done after starting therapy) and re/vaccinate if not immune.
  • Avoid live vaccines within 4 weeks of starting therapy and during therapy
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete annual TB risk assessment and screening if meeting criteria for high risk.
  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic. (This can be considered shorty after starting therapy).
Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

biologics – α4 integrin (natalizumab)

Tysabri®

Prior to Initiating Therapy

  • Enroll in TOUCH program.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.

biologics – IL-12/23 (ustekinumab)

IL-23 (risankizumab, mirikizumab)

Stelara®

Skyrizi®

Omvoh®

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Avoid live vaccines within 4 weeks of starting therapy.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete annual TB risk assessment and screening if meeting criteria for high risk.
  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months. For Skyrizi, liver function monitoring is recommended within the first 3 months of initiating therapy, and up to 6 months for Omvoh.
    .
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic.
Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

biologics – α4β7 integrin (vedolizumab)

Entyvio®

Prior to Initiating Therapy

  • Optional: Patients at high risk for tuberculosis (TB) may be screened for TB, at discretion of the provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Avoid live vaccines within 4 weeks of starting therapy.

While on Therapy

  • Avoid live vaccines.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic.

corticosteroids – budesonide

Entocort® EC

Uceris™

  • Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended.
  • Consider an ophthalmology exam to monitor for ocular side effects.
  • Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary.

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

corticosteroids – prednisone

A-Methapred®
Depo-Medrol®
Medrol Dosepak®
Solu-Medrol®
Deltasone®
Oraped®
Prelone®
Pediapred®

  • Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended.
  • Consider an ophthalmology exam to monitor for ocular side effects.
  • Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary.

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

immunosuppressant – cyclosporine

Neoral®

Sandimmune®

Gengraf®

Prior to Initiating Therapy

  • Review all medications, including herbal supplements, with provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels.

While on Therapy

  • Avoid grapefruit juice.
  • Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol and magnesium levels every 3-6 months.
  • Ensure consistency of taking medication, either always with food or always without food.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

immunosuppressant – methotrexate

Rheumatrex®

MTX®

Mexate®

Trexall®

Prior to Initiating Therapy

  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Take daily folic acid supplements (1 mg/day).

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.

immunosuppressant – tacrolimus

Prograf®

Astagraf XL®

Envarsus® XR

Hecoria®

Prior to Initiating Therapy

  • Review all medications, including herbal supplements, with provider.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels.

While on Therapy

  • Avoid grapefruit juice.
  • Ensure consistency of taking medication, either always with food or always without food.
  • Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels every 3-6 months.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider

immunosuppressant – thiopurine, azathioprine, 6-Mercaptopurine (6-MP)

Imuran®

Azasan®

Purinethol®

Purixan

Prior to Initiating Therapy

  • Complete Thiopurine methyltransferase (TPMT) enzyme blood test to ensure a safe start to the medication. Results can impact starting dose.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system (Thiopurine Metabolites).

NOTE: White blood cell counts should be monitored more often in the first 3 months of therapy.

small molecules – JAK-inhibitor (tofacitinib, upadacitinib)

Xeljanz®

Rinvoq®

Prior to Initiating Therapy

  • Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray).
  • Avoid live vaccines within 4 weeks of starting therapy and during therapy.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Consider the Inactive Herpes Zoster vaccine (Shingrix) especially if you are above the age of 50. Please discuss with your GI provider and primary care provider.

While on Therapy

  • Complete a Fasting Lipid Profile, recommended 4-8 weeks after starting therapy.
  • Complete annual TB risk assessment and screening if you meet criteria for high risk.
  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list.
Considering Pregnancy? Your GI provider may need to adjust your IBD care plan, so please include your GI provider in discussions when family-planning.

small molecules – S1P Receptor Molecules (ozanimod, etrasimod)

Zeposia®

Velsipity®

Prior to Initiating Therapy

  • Complete an Electrocardiogram (EKG) to screen for preexisting heart rhythm abnormalities.
  • Complete blood pressure monitoring
  • Review all your medications with your provider to ensure they don’t impact your heart rate.
  • Visit an ophthalmologist prior to or near the start of treatment especially if you have diabetes or if you are diagnosed with inflammation or swelling inside your eye.
  • Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)].
  • Consider the Inactive Herpes Zoster vaccine (Shingrix), especially if above the age of 50. Please discuss with your GI provider and primary care provider.
  • Skin checks are recommended prior to or near the start of treatment.

While on Therapy

  • Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months.
  • Skin and eye examinations are recommended periodically while on therapy.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.

Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.