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Alyssa Parian, MD

Co-Clinical Director of Gastroenterology & Hepatology at Johns Hopkins School of Medicine

Q: Hello, I'm 58 years old and was diagnosed with Crohn's a year ago. I've been receiving infusions of Inflectra every 8 weeks which may be helping because my calprotectin is back to normal. I will know more when I have the next capsule endoscopy. Meanwhile, I am wondering if it is normal to be very tired after the infusions. I am sleeping for hours and don't feel like I can do anything for a couple of days.

A: I agree with your work up to make certain first that the disease is in complete remission and it’s not active disease and inflammation causing your symptoms. Another suggestion could be to determine if you are getting any pre-medications with your infusions such as Benadryl which can cause fatigue and discussing with your providers if there is a -non-drowsy option you could use for premedication instead. Lastly, I would check to see if your vitamin levels have been checked especially your vitamin B12 levels. This is absorbed in the ileum which it seems may be the area of your Crohn’s disease and can commonly be low in Crohn’s patients. Low B12 is associated with fatigue and repletion of this can help energy levels. Additionally, making sure iron levels and vitamin D are replete are also critical. Crohn’s disease has been associated with a chronic fatigue even when in remission that can affect certain people. There is ongoing research in this field to better understand the causes and therefore formulate better therapies to treat it. This is a diagnosis of exclusion and would explore other diagnoses first including checking in with your primary care doctor to make sure other organ systems are checked such as thyroid. One method that helps patients is to increase exercise to 5 times a week for at least 30 minutes. This tends to increase energy. hide answer