8 Common Medications That Can Exacerbate IBD Symptoms
Health ConditionsDigestive HealthIBD

8 Common Medications That Can Be Surprisingly Tough on an IBD Gut

8 Common Medications That Can Be Surprisingly Tough on an IBD Gut
Everyday Health
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Published on August 17, 2026
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You may be aware that stress or certain foods can affect your inflammatory bowel disease (IBD). But did you know that some medications — including those that you can get over-the-counter — could also add to your symptoms?

Certain meds are known for causing gastrointestinal (GI) side effects that you may already be dealing with as part of your Crohn’s disease or ulcerative colitis (UC). Others could affect your gut microbiome or have other effects that could make a flare more likely. In both cases, understanding the risks and talking with your gastroenterologist can help you make better-informed choices and sidestep any surprises.

So, which medications should you be wary of? Here are eight drugs to be careful with when you have IBD.

1. NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin) and naproxen (Aleve) aren’t the best option for pain relief when you have Crohn’s or UC, because they may raise your risk of a flare.

“The higher the frequency, the greater the risk,” says Kelsey Able, DO, a gastroenterologist at Consultants in Gastroenterology and a supervising clinical practitioner at Kansas City University College of Osteopathic Medicine in Kansas City, Missouri.

For most people with an IBD, a non-NSAID pain reliever like acetaminophen (Tylenol) is a better choice.

 COX-2 inhibitor NSAIDs like celecoxib (Celebrex) may be another option, as they pose a lower potential flare risk than other NSAIDs.

 Talk with your gastroenterologist to choose the right medication for you.

In certain situations, your doctor might decide that the benefits of a certain NSAID may outweigh the risks. “Low-dose aspirin for cardiovascular reasons is generally okay. And in pregnant patients with IBD, we recommend two low-dose aspirin in collaboration with obstetrics and gynecology to prevent preeclampsia after week 12 of pregnancy,” says Iana Stonier, MD, a codirector of the inflammatory bowel disease center at Henry Ford Health in Detroit.

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2. Certain Antibiotics

Antibiotics can disrupt the balance of bacteria in your GI tract, which could increase the chances of a flare. The risk is highest within two weeks of broad-spectrum oral antibiotics, which are effective against a wide range of bacteria, like quinolones, penicillins, nitroimidazoles, and macrolides, according to research. Antibiotics given by IV don’t seem to raise flare risk, however.

Despite the potential hazard, antibiotics are still sometimes needed to fight off infections. The key to minimizing your flare risk is saving them for when they’re truly needed — a decision you and your doctor can make together.

 “Broad-spectrum antibiotics require judicious use. While clinical indications vary, therapy should always align with established guidelines and evidence-based antibiotic stewardship,” Dr. Stonier says.

3. Proton Pump Inhibitors (PPIs)

These medications, including esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec), can be helpful for managing acid reflux. But some studies link PPI use to greater IBD severity and lower remission rates. So it’s often recommended that people with Crohn’s or UC avoid using them long-term.

If you’re struggling with acid reflux, let your gastroenterologist know. They may start by recommending lifestyle changes or a histamine 2 (H2) blocker like famotidine (Pepcid) or ranitidine (Zantac), Dr. Able says.

If those options don’t give you the relief you need, you can talk about ways to use a PPI as safely as possible. “We may prescribe one for short-term use. It’s important to use the lowest dose with maximum effect,” says Stonier.

4. Antidiarrheal Meds

Antidiarrheals like loperamide (Imodium) slow down your bowel movements and make them firmer. But they’re often not a good choice for people with IBD, especially if you have a stricture or if your diarrhea is caused by an IBD flare.

 “I always recommend my patients ask me before using them,” says Able.
That’s because these medications can raise the risk for a severe complication called toxic megacolon, where the colon fills with gas and ruptures, causing bacteria from the colon to spill into the bloodstream.

If you’re having trouble with urgency or loose stools, let your gastroenterologist know. Together you can decide if an antidiarrheal is appropriate for you, and if so, how much to take.

5. Laxatives

If you’re struggling with constipation — which can happen for many people with IBD — the right laxative may be an option to get things moving again. But it’s important to talk with your gastroenterologist first, since certain types may be better than others. Laxatives also aren’t safe if you have a stricture.

 “Knowing a patient’s anatomy and disease state helps us work together on a plan for laxatives,” Able says.
If you don’t have a stricture, your doctor may recommend starting with lifestyle changes (like drinking more water or eating more fiber) or trying a fiber supplement like psyllium, which makes stools softer and bulkier so they can pass more easily. If that doesn’t help, they may recommend an osmotic laxative like polyethylene glycol (Miralax).

 Just keep in mind that both can sometimes cause or worsen symptoms you may already be experiencing, like gas or cramping.

6. GLP-1s

Glucagon-like peptide-1 (GLP-1) receptor agonist medications like semaglutide (Ozempic, Wegovy), and tirzepatide (Mounjaro, Zepbound) are generally considered safe for people with IBD. But since they’re known for causing side effects like nausea, diarrhea, and constipation, it’s possible that a diabetes or weight loss drug could add to symptoms that you may already be dealing with.

Another important thing to keep in mind: Since GLP-1s suppress your appetite, they could make you more prone to nutrient deficiencies — which is already a risk when you have Crohn’s or UC.

 “With any patient on these meds, careful nutritional goals and practices should be followed to avoid malnourishment due to rapid weight loss,” Able says.

7. Opioid Pain Relievers

Opioid pain relievers are generally only recommended for people with severe pain that can’t be treated with other medicines. That’s especially true for people with IBD, as they can lead to severe digestive issues.

 “Our IBD guidelines and clinical practices strongly discourage opioid use in IBD patients due to concerns for worsening inflammation, bowel obstruction, and increased risk for infection and mortality,” says Stonier.

If you’re struggling with chronic pain, let your doctor know so you can discuss your options. Pain that’s related to your Crohn’s or UC in particular could be a sign that your IBD isn’t well-controlled, Stonier says. In that case, you and your gastroenterologist can talk about making changes to your treatment plan.

8. Magnesium Supplements

Magnesium isn’t a medication; it’s a supplement that many use to improve sleep, manage fatigue, and ease muscle cramps. Unfortunately, it also has the potential to irritate your GI tract and worsen IBD symptoms that you might already be dealing with, like loose stools or diarrhea.

Paying attention to the type of magnesium can lower the likelihood that this will happen to you. Forms like magnesium glycinate are generally considered to be gentler on the digestive tract than magnesium citrate or magnesium oxide, which can increase diarrhea if an individual has looser stools due to IBD, says Able.

 Always check with your doctor before adding a new supplement to your routine.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  3. Hijos-Mallada G et al. NSAIDs, Gastrointestinal Toxicity and Inflammatory Bowel Disease. Gastroenterología y Hepatología. March 2022.
  4. Zhang Y et al. Association Between Antibiotic Use for Nongastrointestinal Infections and Inflammatory Bowel Disease Flare-Ups: A Self-Controlled Case Series Study. The American Journal of Gastroenterology. January 13, 2026.
  5. Liang Y et al. Effects of Proton Pump Inhibitors on Inflammatory Bowel Disease: An Updated Review. World Journal of Gastroenterology. June 7, 2024.
  6. Other Treatments. Crohn’s & Colitis UK. December 2023.
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  9. Colwill M et al. Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Inflammatory Bowel Disease: Mechanisms, Clinical Implications, and Therapeutic Potential. Journal of Crohn’s & Colitis. September 2025.
  10. Jablońska B et al. Nutritional Status and Its Detection in Patients with Inflammatory Bowel Diseases. Nutrients. April 20, 2023.
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  12. Magnesium Glycinate: Is This Supplement Helpful for You? Mayo Clinic. February 7, 2024.
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