PRN Medications: What, Why, When & How?

As someone who has lived with Crohn’s disease for quite a long time now, I feel like I’ve figured a few things out that I wish I had known a long time ago. One of those things – the as-needed or PRN medications to help manage extra or intensified symptoms.

What is a PRN medication?

The term PRN came from the Latin phrase "pro re nata" – which translates in English to "when necessary." Unlike routine medications that are taken daily or biologics administered on a set schedule to manage overall disease state, PRN medications are not taken on a routine basis, they are only used when needed.

So what medications would be considered PRN? And why would I need them?

I’ll start with an easy example – Tylenol/acetaminophen is considered a PRN medication for most individuals. It’s not something taken daily, or long term, rather when a specific ache or pain arises.

In my experience, PRN medications with IBD usually have specific intentions. Here’s what’s currently in my medicine cabinet for PRN use.

PRN medications for my IBD symptoms

Symptom: diarrhea

One of my major IBD symptoms with or without a flare is diarrhea. When the number of times per day that I visit the restroom begins to increase enough that I notice, it's time for some PRN medication – an anti-diarrheal. I utilize both over-the-counter Immodium and prescription Lomotil (generic: Diphenoxylate/Atropine), depending on a variety of factors at the time.

Symptom: nausea

Nausea has plagued me on and off for years in relation to my Crohn's disease. While some homeopathic methods (ginger ale, peppermint, acupressure) have provided small amounts of relief, I've learned that prescription Zofran (generic: Ondansetron) is something I must keep on hand in order to continue functioning as best as possible.

Honestly, I would consider Zofran a key medication in managing my Crohn's disease, even though I don't take it daily or at routine intervals.

Symptom: GI spasms

My doctor has always recommended keeping an anti-spasmodic/anticholinergic medication such as Bentyl (generic: Dicyclomine) in my tool chest as well. This is usually medication I take when I'm experiencing extra gas or moderate discomfort, not when I would reach for traditional pain medication.

Symptom: Breakthrough pain

Any IBD patient knows that breakthrough pain is real, and can happen regardless of your disease status. Over the years, with different doctors and in different clinics, I've been prescribed a few different options for dealing with severe IBD pain. Having oral medication like this available PRN has sometimes been the difference for me between staying home and going to the emergency room.

Symptom management with your care team

So how do you speak with your care team about PRN medications?

To be honest, when I was a new patient this was a really hard thing for me to navigate. My Crohn's disease went undiagnosed for several years, during which my symptoms and the intensity of my disease effects were often questioned. So, standing up for and advocating for myself with my regular doctors has taken a lot of practice.

Here are three things I think can help if you're struggling with the same:

Log symptoms

Keep a list or log of the symptoms that you experience outside of your norm. It helps to note how often they are occurring, and their intensity (i.e., if they kept you from participating in an event, from eating, from sleeping, kept you in the restroom for hours, etc.). I've found sometimes it's easier to show something physical to my doctor and have her read it directly.

Log medications

When you're given medications in response to your symptoms – in the ER, while admitted to the hospital, or from your doctor in an outpatient appointment – be sure to make notes of if they help, and how much. Sometimes this is the key to finding the right PRN medication and/or the right dosage.

Assess your IBD treatment plan

If the use of PRN medication becomes too routine for you, it might be time to talk with your doctor about changing your overall IBD treatment plan. If things like pain, nausea, vomiting, increased trips to the bathroom or restroom urgency are heightened for longer periods of time, it might mean that your disease status has changed, that you're experiencing more active disease, and a more aggressive or different treatment plan might be more helpful for you than utilizing PRN medications around the clock.

If you utilize PRN medications to help manage living with IBD, what have you found most helpful, both in terms of medication and advocating for yourself?