# Crohn's Disease Primary Care Support & Referral - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Endocrine System 2024 · ACG Clinical Guideline: Management of Crohn's Disease in Adults 2018 · ENTYVIO (vedolizumab) for injection US prescribing information, section 1 Indications and Usage, section 2.2 Recommended Dosage in Adults with Ulcerative Colitis and Crohn's Disease, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 6e94621c-1a95-4af9-98d1-52b9e6f1949c) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Endocrine System 2024 - ACG Clinical Guideline: Management of Crohn's Disease in Adults 2018 - Crohn's Disease Primary Care Support & Referral - disease-level clinical article (crohn-disease-referral-full.txt) - Crohn's Disease Primary Care Support & Referral - disease-level clinical article (crohn-disease-referral-clinical.txt) - ENTYVIO (vedolizumab) for injection US prescribing information, section 1 Indications and Usage, section 2.2 Recommended Dosage in Adults with Ulcerative Colitis and Crohn's Disease, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 6e94621c-1a95-4af9-98d1-52b9e6f1949c) ## Treatment metadata - Budesonide — 3 mg — oral.solid - Referral & safety-netting (no drug therapy) - Prednisolone — 5 mg — oral.solid - Vedolizumab — 300 mg — injection ## Complete treatment card ```text CROHN'S DISEASE PRIMARY CARE SUPPORT & REFERRAL Sources: Egyptian National Drug Formulary - Endocrine System 2024 · ACG Clinical Guideline: Management of Crohn's Disease in Adults 2018 · ENTYVIO (vedolizumab) for injection US prescribing information, section 1 Indications and Usage, section 2.2 Recommended Dosage in Adults with Ulcerative Colitis and Crohn's Disease, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 6e94621c-1a95-4af9-98d1-52b9e6f1949c) Review status: REVIEWED against Egyptian National Drug Formulary - Endocrine System 2024, ACG Clinical Guideline: Management of Crohn's Disease in Adults 2018, Crohn's Disease Primary Care Support & Referral - disease-level clinical article (crohn-disease-referral-full.txt), Crohn's Disease Primary Care Support & Referral - disease-level clinical article (crohn-disease-referral-clinical.txt), ENTYVIO (vedolizumab) for injection US prescribing information, section 1 Indications and Usage, section 2.2 Recommended Dosage in Adults with Ulcerative Colitis and Crohn's Disease, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 6e94621c-1a95-4af9-98d1-52b9e6f1949c) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Recurrent mild abdominal pain, diarrhea, and low-grade fever alternate with symptom-free weeks to months [abdominal pain · diarrhoea · fever] - Ileocolitis causes recurrent right lower quadrant colicky pain relieved by defecation [abdominal pain] - Weight loss is common from chronic diarrhea and reduced oral intake [diarrhoea · weight loss] - Enterovesical fistula can cause dysuria, pneumaturia, or recurrent urinary tract infections [burning on passing urine · fistula] - Jejunoileal disease leads to malabsorption and steatorrhea [steatorrhoea] - Perianal Crohn disease causes hematochezia, painful defecation, anorectal pain, and fistulae [fistula] - Upper GI involvement causes nausea, vomiting, and epigastric pain [abdominal pain · epigastric pain · nausea · vomiting] SIGNS - what you find (7) - A palpable inflammatory mass may be felt in the right lower quadrant - Pallor and low body weight reflect malnutrition on general exam [pallor] - Vital signs may show fever, tachycardia, or hypotension [fever · hypotension · tachycardia] - Hyperactive bowel sounds suggest inflammation or obstruction; absent sounds suggest ileus - Abdominal guarding points to peritonitis from perforation or abscess [abscess · guarding] - Erythema nodosum or pyoderma gangrenosum may appear on the skin [redness] - Right upper quadrant tenderness and jaundice suggest hepatobiliary involvement [abdominal pain · jaundice · right upper quadrant pain] TESTS (8) - Stool calprotectin detects active disease and tracks disease activity over time - CBC may reveal anemia from vitamin B12 or iron deficiency - ANCA and ASCA antibody panels are not routinely used to separate Crohn disease from ulcerative colitis - The classic string sign on small bowel follow-through reflects a stricture or spasm - MRI is preferred over CT in children to limit radiation exposure - Video capsule endoscopy risks capsule retention in patients with known strictures - Baseline TB screening is recommended before starting anti-TNF biologics - TPMT activity is checked before starting thiopurine therapy IF NOT THIS - what else fits (6) - Intestinal tuberculosis is a differential for ileitis - Behcet disease is on the differential list - Diverticulitis is a differential, especially for colonic involvement - Drug-induced colitis from NSAIDs or immunotherapy is a differential - Ischemic colitis is on the differential list - Amebic colitis is a differential, particularly with a relevant travel history Source StatPearls "Crohn Disease" - disease-level clinical article Status traced to the source above Rx: Main treatment | Gut-selective anti-integrin biologic for induction and maintenance - hospital-initiated MAIN TREATMENT - choose one 1. BUDESONIDE [1st line] Adult 9 mg once daily in the morning 30 minutes before breakfast x 8 weeks Peds 9 mg once daily for 8 weeks in children >50 kg under pediatric gastroenterologist care Source Egyptian National Drug Formulary - Endocrine System 2024 (budesonide monograph), Oral, Crohn disease, mild to moderate (active): "Initial: 9 mg once daily in the morning for 2-4 weeks up to 8 weeks if needed". The band in the formulary is 8 years and over weighing >25 kg, wider than the >50 kg shown here. The ACG Crohn's disease guideline is not held in this corpus. Why Preferred oral corticosteroid for inducing remission in mild-to-moderate ileocecal Crohn's disease due to low systemic bioavailability Caution Indicated specifically for mild-to-moderate ileal or right-colon Crohn's disease. Taper dose to 6 mg daily for 2 weeks, then 3 mg daily for 2 weeks before stopping. SPECIALIST GASTROENTEROLOGY REFERRAL IS MANDATORY. Egypt BUDECORT 400 DP 30 CAPS+INHALER CIPLA LTD. - ... 34.00 EGP (1.13/unit) -> ? strength differs EKMASONID 9 MG 10 E.R. F.C. TABS. HIKMA PHARMA 123.00 EGP -> ? strength differs CORTIMENT MMX 9 MG 30 PROLONGED REL. TABS. FERRING PHARMACEUTICALS > MUL... 1500.00 EGP -> ? strength differs 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Crohn's Disease Primary Care Support & Referral - disease-level clinical article (crohn- disease-referral-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Prolonged corticosteroid therapy for maintenance is explicitly warned against, due to severe chronic adverse effects. RED FLAG - The surgical referral criteria are bowel obstruction, fibrostenotic strictures, fistulas, recurrent abscesses, and dysplasia. 3. PREDNISOLONE [2nd line] Adult 40 mg once daily in the morning, tapering by 5 mg weekly x 8 weeks tapering course Peds 1 mg/kg/day [child max 40 mg] (1 mg/kg daily (max 40 mg) tapering over 6-8 weeks) 3kg -> 3 mg/day 4kg -> 4 mg/day 5kg -> 5 mg/day 6kg -> 6 mg/day 7kg -> 7 mg/day 8kg -> 8 mg/day 9kg -> 9 mg/day 10kg -> 10 mg/day 11kg -> 11 mg/day 12kg -> 12 mg/day 13kg -> 13 mg/day 14kg -> 14 mg/day 15kg -> 15 mg/day 16kg -> 16 mg/day 17kg -> 17 mg/day 18kg -> 18 mg/day 19kg -> 19 mg/day 20kg -> 20 mg/day 21kg -> 21 mg/day 22kg -> 22 mg/day 23kg -> 23 mg/day 24kg -> 24 mg/day 25kg -> 25 mg/day 26kg -> 26 mg/day 27kg -> 27 mg/day 28kg -> 28 mg/day 29kg -> 29 mg/day 30kg -> 30 mg/day 31kg -> 31 mg/day 32kg -> 32 mg/day 33kg -> 33 mg/day 34kg -> 34 mg/day 35kg -> 35 mg/day 36kg -> 36 mg/day 37kg -> 37 mg/day 38kg -> 38 mg/day 39kg -> 39 mg/day 40kg -> 40 mg/day 41kg -> 40 mg/day (capped) 42kg -> 40 mg/day (capped) 43kg -> 40 mg/day (capped) 44kg -> 40 mg/day (capped) 45kg -> 40 mg/day (capped) 46kg -> 40 mg/day (capped) 47kg -> 40 mg/day (capped) 48kg -> 40 mg/day (capped) 49kg -> 40 mg/day (capped) 50kg -> 40 mg/day (capped) Source ACG Clinical Guideline: Management of Crohn's Disease in Adults 2018 Why Systemic corticosteroid used to induce remission during an acute moderate-to-severe flare of Crohn's disease by suppressing the underlying inflammatory response; not used for long-term maintenance. Caution Used for acute moderate-to-severe disease flares. Systemic side effects include hypertension, hyperglycemia, mood changes, and osteoporosis. Never stop abruptly after prolonged use. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid GUT-SELECTIVE ANTI-INTEGRIN BIOLOGIC FOR INDUCTION AND MAINTENANCE - HOSPITAL-INITIATED 4. VEDOLIZUMAB [3rd line] Adult Intravenous infusion at a fixed 300 mg dose, not by weight. US label verbatim: "Week 0: Administer ENTYVIO 300 mg by intravenous infusion over approximately 30 minutes. Week 2: Administer ENTYVIO 300 mg by intravenous infusion over approximately 30 minutes. Week 6: Patients may remain on ENTYVIO intravenous therapy or switch to subcutaneous injection after receiving two ENTYVIO intravenous doses administered at Week 0 and Week 2. Intravenous Infusion: Administer ENTYVIO 300 mg by intravenous infusion over approximately 30 minutes and then every eight weeks thereafter. Subcutaneous Injection: Administer ENTYVIO 108 mg subcutaneously once every 2 weeks." - Judged at week 14 and stopped there if nothing has changed. US label verbatim: "Discontinue therapy in patients who show no evidence of therapeutic benefit by Week 14." Peds Not a paediatric prescription on this label. US label verbatim: "Safety and effectiveness of ENTYVIO in pediatric patients have not been established." A child or adolescent with inflammatory bowel disease belongs with paediatric gastroenterology. Source ENTYVIO (vedolizumab) for injection US prescribing information, section 1 Indications and Usage, section 2.2 Recommended Dosage in Adults with Ulcerative Colitis and Crohn's Disease, section 4 Contraindications and section 5 Warnings and Precautions (DailyMed SetID 6e94621c-1a95-4af9-98d1-52b9e6f1949c) Why The disease article names the drug and what it does in this disease, verbatim: "Vedolizumab, the agent in this class used for Crohn disease, has demonstrated superior efficacy compared with placebo in both inducing and maintaining remission, with or without concomitant immunomodulators." The US label's indication section names the disease, verbatim: ENTYVIO "is indicated in adults for the treatment of: moderately to severely active Crohn's disease (CD)." The card carried budesonide and prednisolone alone - the steroids that induce remission and cannot maintain it - so the maintenance step the article describes was not shown at all. Gastroenterology starts it. Caution Tuberculosis is assessed before the first infusion. US label verbatim: "Consider evaluating patients for TB infection prior to initiating treatment with ENTYVIO. Treatment with Entyvio should not be administered to patients with active TB infection. Initiate treatment of latent TB prior to administering ENTYVIO." Latent tuberculosis is common in Egypt, so this is a real gate rather than a formality. Infection risk is lower than with the anti-TNF drugs but it is not absent. US label verbatim: "Patients treated with ENTYVIO are at increased risk for developing infections. Serious infections reported in clinical trials include anal abscess, sepsis (some fatal), tuberculosis (TB), salmonella sepsis, Listeria meningitis, giardiasis, and cytomegaloviral colitis." and "Treatment with ENTYVIO should not be initiated in patients with a clinically important active infection until the infection resolves or is adequately treated." RED FLAG - new neurological symptoms. US label verbatim: "Monitor patients on ENTYVIO for any new onset, or worsening, of neurological signs and symptoms. Typical signs and symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes... If PML is suspected, withhold dosing with ENTYVIO and refer to a neurologist; if confirmed, discontinue dosing permanently." Infusion and hypersensitivity reactions, including anaphylaxis. US label verbatim: "Infusion-related reactions and hypersensitivity reactions have been reported, including anaphylaxis, dyspnea, bronchospasm, urticaria, flushing, rash, and increased blood pressure and heart rate. These reactions may occur with the first or subsequent infusions of ENTYVIO and may vary in their time of onset from during infusion or up to several hours post-infusion." It is given by staff able to treat anaphylaxis, and a prior severe reaction to it is a contraindication. Liver injury. US label verbatim: "ENTYVIO should be discontinued in patients with jaundice or other evidence of significant liver injury." Get the vaccinations done first. US label verbatim: "Prior to initiating treatment with ENTYVIO, all patients should be brought up to date with all immunizations according to current immunization guidelines." A hospital drug, not a prescription-pad drug. Egypt registers one product, ENTYVIO 300 mg vial for infusion at roughly 48,800 EGP, and an eight-weekly schedule means that cost recurs. The regimen is printed here so a shared-care clinic can recognise it, hold it during infection and know when the next infusion is due. Egypt ENTYVIO 300 MG VIAL FOR INF. TAKEDA > PHAR... 48824.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)