COVID-19 & IBD Medication
You probably have questions about your IBD medications and wonder if they increase your risk for contracting SARS-CoV-2 and developing COVID-19. The information below is based on the latest information and research available—we are learning new things everyday about COVID-19, and the information changes frequently. Please discuss your medications, disease, and risk with your healthcare provider.
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General medication recommendations without presence of SARS-CoV-2 or COVID-19 infection
- STAY ON YOUR IBD MEDICATIONS. Inflammation due to IBD can lead to complications and damage to your intestinal tract. Your medications aim to keep this inflammation under control. Always talk to your doctor about your treatment plan if you have concerns or questions.
- If you are taking a mesalamine (Asacol®, Apriso™, Canasa®, Delzicol™, Lialda™, Pentasa®, Rowasa®) or other aminosalicylates, these are all safe to continue.
- While taking these medications, you do not need to take extra precautions beyond CDC recommendations regarding proper hygiene (see: What IBD patients should know about the 2019 novel coronavirus).
- Antibiotics are considered safe and should be continued.
- If you are taking steroids (prednisone/prednisolone) for any reason, be sure to take extra precautions by following the CDC’s recommendations for risk reduction and talk to your healthcare provider. While some IBD patients may need to take steroids for a short term (for example less than three months), long term use of steroids can suppress your immune system. Studies have also shown that high dose corticosteroids can lead to an increased risk of severe COVID-19.
- Please discuss with your healthcare provider if there are options to lower your dose or get off steroids (this can also be a goal in generally managing IBD).
- Rectal steroids (Budesonide (Entocort® EC, UCERIS™) are considered safe and should be continued.
- Dietary management is considered safe and should be continued.
- Immunomodulators like thiopurines (azathioprine, 6-mercaptopurine, cyclosporine, methotrexate), tend to inhibit the body’s immune response to viral infections.
- Do not stop taking these medications. If you have concerns, talk to your provider.
- If you have tested positive for SARS-CoV-2 or have COVID-19 see guidance below.
- Targeted synthetic small molecules including tofacitinib (Xeljanz®) and ozanimod (Zeposia®) also may inhibit the body's immune response to viral infections. However general guidance from IBD specialists advise that the medications should be continued.
- Biologics/Biosimilars including adalimumab (Humira®), certolizumab pegol (Cimzia®), infliximab (Remicade®), infliximab-abda (Renflexis®), infliximab-dyyb (Inflectra®), infliximab-qbtx (Xifi™), golimumab (Simponi®), ustekinumab (Stelara®), and vedolizumab (Entyvio®) are immune modifying therapies (see our biologics factsheet for a full listing of anti-TNFs and other biologic therapies).
- Do not stop taking these medications.
- Talk to your healthcare provider before making any adjustments to these medications.
- If your medication requires an infusion please do not skip these appointments. It’s important to stay on your medications and go to infusion appointments as scheduled. If you have concerns about visiting an infusion center:
Medication summary chart
|Medication Category||Examples||Continue taking?|
(Asacol®, Apriso™, Canasa®, Delzicol™, Lialda™, Pentasa®, Rowasa®)
|Yes. Take as prescribed.|
Azathioprine (Azasan®, Imuran®, cyclosporine (Gengraf®, Neoral®, Sandimmune®), mercaptopurine (Purinethol®), methotrexate (Rheumatrex®), tacrolimus (Prograf®)
|Yes. Take as prescribed.|
Anti-TNF biologics certolizumab pegol (Cimzia®),adalimumab (Humira®), infliximab (Remicade®), golimumab (Simponi®), infliximab-abda (Renflexis®), infliximab-dyyb (Inflectra®), infliximab-qbtx (Xifi™). Integrin receptor antagonists like natalizumab (Tysabri®) , vedolizumab (Entyvio®), and interleukin 12 and 23 antagonists like ustekinumab (Stelara®)
|Yes. Take as prescribed.|
|Targeted synthetic small molecules||
tofacitinib (Xeljanz®) and ozanimod (Zeposia®)
|Yes. Take as prescribed.|
Budesonide (Entocort® EC, UCERIS™), methylprednisolone (A-Methapred®, Depo-Medrol®, Medrol Dosepak®, Solu-Medrol®), prednisolone (Orapred®, Prelone®, Pediapred®), prednisone (Deltasone®)
|Do not adjust without speaking to your doctor.|
Examples: Metronidazole (Flagyl®), Ciprofloxacin (Cipro®), Vancomycin (Vancocin®), Rifaximin (Xifaxan®)
|Yes. Take as prescribed.|
Testing positive for SARS-CoV-2 (but not COVID-19)
You may be asked to take a SARS-CoV-2 test before an endoscopic procedure or surgery. Some IBD patients may test positive but not exhibit any symptoms of COVID-19. How does a positive test impact your IBD medications?
If you test positive for the virus and do not have symptoms or signs of the disease, you and your healthcare provider should discuss your medications and make a shared decision on any changes or adjustments to your medications. IBD experts from around the world are currently recommending the following for patients who test positive for SARS-CoV-2 but have not developed COVID-19. This guidance has been recently summarized in an expert commentary article in Gastroenterology.
For the next two weeks (14 days), while waiting to see if COVID-19 develops, adjust treatments as follows:
- Steroids (prednisone/prednisolone) move to a lower dose or transition to oral budesonide when feasible
- Stop thiopurines (azathioprine, 6-mercaptopurine, cyclosporine), methotrexate,
- Stop targeted synthetic small molecules [tofacitinib (Xeljanz®) and ozanimod (Zeposia®)]. This reflects the opinion of the Foundation's medical experts and should be discussed with your doctor, as you would with any changes to your treatment plan.
- Delay dosing of biologics for 2-weeks
- Biologics/Biosimilars include: adalimumab (Humira®), certolizumab pegol (Cimzia®), infliximab (Remicade®), infliximab-abda (Renflexis®), infliximab-dyyb (Inflectra®), infliximab-qbtx (Xifi™), golimumab (Simponi®) ustekinumab (Stelara®), and vedolizumab (Entyvio®) - see our biologics factsheet for a full listing of anti-TNFs and other biologic therapies
Experts recommend re-starting therapy after 2 weeks if COVID-19 has not developed. You and your healthcare provider should discuss any changes to your medications. Don’t stop taking medications without talking to your doctor.
If you've tested positive for the SARS-CoV-2 virus and have symptoms, signs or laboratory findings of COVID-19, it is important to make sure the physician treating you for COVID-19 knows that you have Crohn’s disease or ulcerative colitis and have this person communicate directly with your gastroenterologist. Make sure to share all the medications you are taking with your treatment team. Experts are currently recommending the following approach to IBD therapies:
- Aminosalicylates (Asacol®, Apriso™, Canasa®, Delzicol™, Lialda™, Pentasa®, Rowasa®) or other aminosalicylates are considered safe and may be continued.
- Antibiotics for Crohn’s disease (usually perianal disease) are considered safe and may be continued.
- Topical rectal therapy like mesalamine suppositories (CanasaTM) or enemas (RowasaTM) or budesonide foam (UCERIS™) is considered safe and may be continued.
- Oral budesonide (Entocort® EC or UCERISTM) is considered safe and may be continued.
- Oral steroids should be reduced and discontinued if possible.
- Patients and healthcare providers should discuss how to reduce steroids quickly and safely
- Immunomodulators should be stopped until you recover from COVID-19.
- Immunomodulators include: Azathioprine (Azasan®, Imran®, cyclosporine (Gengraf®, Neoral® Sandimmune®), mercaptopurine (Purinethol®) methotrexate (Rheumatrex®) tacrolimus (Prograf®),
- Targeted synthetic small molecules should be stopped until you recover from COVID-19 including tofacitinib (Xeljanz®) and ozanimod (Zeposia®). This reflects the opinion of the Foundation's medical experts and should be discussed with your doctor, as you would with any changes to your treatment plan. Call your doctor first and inform him/her of your situation for their guidance on any changes to IBD medications.
- Anti-TNF biologics should be stopped until you recover from COVID-19.
- Anti-TNF’s biologics/biosimilars include: adalimumab (Humira®), certolizumab pegol (Cimzia®), golimumab (Simponi®), infliximab (Remicade®),infliximab-abda (Renflexis®), infliximab-dyyb (Inflectra®), infliximab-qbtx (Xifi™)
- Ustekinumab (Stelara®) should be stopped until recovery from COVID-19.
- Vedolizumab (Entyvio®) should be stopped until recovery from COVID-19.
Before any changes are made to your medications, it's important to make sure the physician treating you for COVID-19 communicates directly with your gastroenterologist or the healthcare provider managing your IBD. Don’t stop taking medications without ensuring your COVID-19 care is coordinated with the healthcare provider managing your IBD.
Research continues around the impact of COVID-19 on the IBD community. Physicians and scientists are constantly learning new information and reevaluating recommendations. The decisions around how to treat IBD while you have COVID-19 are complex; you and your healthcare team should discuss your IBD, assess whether your Crohn’s or ulcerative colitis is quiet or active, and then make the appropriate decision for your unique situation.
Research on COVID-19 and IBD
Several research studies working to understand the impact of SARS-CoV-2 on the IBD community are underway world-wide. Some of these studies are working to understand if IBD therapies may be protective against contracting SARS-COV-2, while other studies are focused on assessing risk on specific populations, like pregnant women, or understanding if children with IBD respond differently, and what role supplements may or may not play in protecting against or reducing the duration of COVID-19.
Any information shared by the Foundation or your healthcare provider about ongoing research or hypotheses that are currently being tested summarizes what is being looked at. In some cases, we may share early data as well—it’s important to remember that this is not the final study results unless indicated otherwise. In sharing updates about research, the Foundation and your healthcare providers strive to keep you informed about the latest information. Some of the approaches they describe, or therapies now being evaluated, will fail. The purpose of all this research is to test new ideas in order to learn how diseases develop and impact communities. We want you to understand what’s in progress, but theory that’s being tested doesn’t mean it is proven. Once a definitive study finding or peer-reviewed guideline is available, the Foundation will share it widely.
For information about clinical trials focused on developing vaccines, treatments, and many other studies related to COVID-19, please visit COVID-19 Clinical Trials.
This information was developed by members of the Foundation's National Scientific Advisory Committee.