Ulcerative Colitis Medications

Written by WebMD Editorial Contributor, Marijke Vroomen Durning, RN
Medically Reviewed by Zilpah Sheikh, MD on September 05, 2024
10 min read
Treatments Based on the Severity of Your UCDoctors first have to find out whether your ulcerative colitis is a mild case or more severe. Here are the different treatments they consider.158

[MUSIC PLAYING]

AJA MCCUTCHEN: In assessing

a patient and trying to help

them make an informed decision

on what the best treatment

options are, there is no

one-size-fits-all all formula,

unfortunately.

We have to look at a variety

of factors.

But there is a general consensus

on how we divide the patients

in terms of risk factors

and where we may start

with our therapies.



So we start with,

"Does this patient have

mild disease?"

That's going to be

minimal disease activity that we

think we can easily control,

and not having

high-risk factors.

So when we're choosing

a therapy, we're going to choose

certain therapies

for mild disease.

Those therapies are going to be

topical anti-inflammatories,

and they can take them by mouth,

and/or oral steroid therapy.

And those therapies, we tend

to not want to give

systemic steroid therapies,

but there are other formulations

of steroid-like therapies

that we can give

in a mild patient.



And then there

is moderate to severe disease.

This patient is being affected

in their daily lives

by this ulcerative colitis

diagnosis and some

of the symptoms, and they are

at higher risk of complications

from the disease.

We want to make sure that we get

on top of their disease

immediately to prevent

any untoward outcomes.

In those cases,

we're going to start talking

about medications that are going

to help to regulate

the immune system a little bit

more aggressively.



And there are

several medications that are

going to fall

into those categories.

There are immunomodulator

therapies, where we're trying

to control the overactive immune

system, or the imbalance

in the immune system.

There's going to be

biological therapies, which are

drugs that are working

systemically

on certain receptors that are

driving the inflammation.

And then there are a new class

of therapies, which are called

small molecules.



And these small molecules

are very specific, targeted

therapies that are working

on the colon and rectum,

specifically reducing

inflammation.

Our goal is to have the patient

have a normal everyday life,

have a good quality of life,

and we want to make sure

that they don't end up

with hospitalizations

and surgeries.

<p>Aja McCutchen, MD<br/>Gastroenterologist, Atlanta Gastroenterology</p>/delivery/aws/5f/79/5f7921b0-990b-4b3d-9b33-83a00367c16f/b03660f3-5359-42f7-885c-079678e2323d_3277473_03_expert_feature_uc_treatments_based_on_severity_122321_,4500k,2500k,1000k,750k,400k,.mp401/05/2022 05:28:00 AM18001200photo of doctor talking to patient/webmd/consumer_assets/site_images/article_thumbnails/video/1800x1200_3277473_03_expert_feature_uc_treatments_based_on_severity_video.jpg091e9c5e822fb9b6

Ulcerative colitis (UC) medications are drugs that help you manage the symptoms and progression of ulcerative colitis. Because UC affects your autoimmune system, the drugs that treat it are meant to lower inflammation or stop your immune system from mistakenly attacking your gut.

Medications are the standard treatment for ulcerative colitis, but some people need to try different UC medications or a combination of them before they start to feel better. There are several major classes (groups) of prescription medications that doctors use to treat the disease and manage flare-ups.

You don’t need a prescription to buy over-the-counter (OTC) drugs, and they can be helpful when you’re not feeling well. That said, these drugs are still medications and should be used with caution.

Be sure to follow the instructions and always check with your doctor before you use any OTC medications for ulcerative colitis. They may interact with medications you’re already taking, which can lead to bad reactions and raise your risk of complications.

If you take any prescription medications, check with your pharmacist if it’s safe for you to use OTC products.

Diarrhea. Many people with ulcerative colitis get diarrhea. If you want to use an OTC product, such as loperamide (Imodium A-D) to manage severe diarrhea, it’s important to speak with your doctor first. Anti-diarrhea medications can cause a serious complication called toxic megacolon.

Pain. If you have pain, your doctor may suggest acetaminophen. Be careful when taking OTC pain relievers such as ibuprofen (Advil), naproxen (Aleve), and diclofenac sodium (Voltaren), as they can worsen your symptoms and make your disease more severe. 

Supplements for ulcerative colitis

Some supplements on the market might help you manage your ulcerative colitis or the effects it has on your body.

Bleeding. If you often have bleeding related to your ulcerative colitis, the blood loss can result in low iron in your blood. This can lead to anemia. You might need iron supplements, but check with your doctor first because there are different types and doses of supplements. Don’t take them without your doctor’s go-ahead.

Spasms. If you get painful spasms, peppermint oil capsules might help.

Your doctor might also recommend other supplements, such as:

Doctors prescribe UC medications that target inflammation because if you can reduce your gut inflammation, you might be able to control the symptoms.

Aminosalicylates

Many people with mild to moderate UC take a class of prescription drugs called aminosalicylates (or “5-ASAs”). These work to reduce inflammation in your gut, putting you into remission and hopefully keeping you there. 

Aminosalicylates include:

  • Balsalazide (Colazal)
  • Mesalamine (Apriso, Asacol HD, Delzicol, Lialda, Pentasa, Canasa, Rowasa)
  • Olsalazine (Dipentum)
  • Sulfasalazine (Azulfidine)

Which one you take, and whether it’s taken by mouth, as an enema, or suppository depends on the area of your colon that's affected and how severe your illness is. If the inflammation is in your rectum, suppositories are usually better than taking pills. Suppositories deliver the medications directly to the area. Some people take both suppositories and pills. Enemas go higher in the colon to deliver the medication. If you have left-sided colon inflammation, you might benefit from this.

You might need other medications if your condition is more severe or if the standard treatments stop working. Some people may also need surgery.

Aminosalicylate side effects

Most people tolerate these drugs well, but there can be side effects. The most common ones include:

  • Headache
  • Nausea
  • Abdominal pain and cramping
  • Loss of appetite
  • Vomiting
  • Rash
  • Fever

Corticosteroids

If you have severe UC symptoms, your doctor may recommend corticosteroids, also called glucocorticoids. They’re often called “steroids” for short. They aren’t the kind of steroids some people misuse to gain muscle, so you won’t bulk up. Corticosteroids turn down your immune system to fight inflammation. You can take them as pills, through an IV, or with an enema or suppositories.

These medications include:

  • Budesonide (Entocort, UCERIS)
  • Methylprednisolone (Depo-Medrol, Medrol Dosepak, Solu-Medrol)
  • Prednisolone (Pediapred)
  • Prednisone

Corticosteroid side effects

Corticosteroids can cause side effects, some serious, especially if taken for a long time. This is why doctors usually limit how long you can take them. Corticosteroid side effects include:

Aminosalicylates and corticosteroids are also used to treat ulcerative colitis flare-ups. Flare-ups happen when your UC symptoms that were previously under control come back for some reason.

Other types of medicines for ulcerative colitis target your immune system to get your symptoms under control.

Immunomodulators

These may be a good option if 5-ASAs and corticosteroids haven’t worked well for you.

They include:

  • Azathioprine (Azasan, Imuran)
  • Cyclosporine (Gengraf, Neoral, Sandimmune)
  • Mercaptopurine (Purinethol, Purixan). 

Due to the risk of side effects, doctors usually save cyclosporine for people who don’t have success with other meds. They may also try methotrexate paired with folic acid.

These drugs can also have side effects. They can cause:

  • Liver damage
  • Skin cancers
  • Lymphoma
  • Weakened immune system, increasing your risk of infections

If you take these immunomodulators, your doctor will test your blood and check you for skin cancer regularly.

Cyclosporine is especially strong, but it works fast. Your doctor might prescribe it to get a severe flare under control, and then give you 6-MP or azathioprine afterward. Side effects can include:

  • Kidney problems
  • Gout
  • Lowered immune system
  • High blood pressure

It can take several months for some of these drugs to work. So, your doctor may give you a faster-acting medicine, such as a low dose of a corticosteroid, to help in the meantime.

Another class of drugs to treat UC is called biologics, but they are usually given to people with moderate-to-severe disease. They can be used with other medications as well. They reduce inflammation and help the colon wall to heal. Most of these medications are given by IV, but some are given by injection. Examples of biologics are:

Biologics side effects

Biologics don’t have as many side effects as other ulcerative colitis drugs, but they can cause:

  • Weakened immune system
  • Allergic reactions
  • Irritation at the injection site

When you take biologics, you're more likely to get tuberculosis, fungal infections, certain kinds of cancers, and other conditions. Your doctor will check for tuberculosis and other infections before prescribing one of these medications and keep a close watch on how you're doing while you take them.

This group of ulcerative colitis medications also targets the immune system. There are three targeted small molecule medications, one is a sphingosine 1-phosphate (S1P) and two are Janus kinase (JAK) inhibitors.

Tofacitinib (Xeljanz) and upadacitinib (Rinvoq) are JAK inhibitors that you take in a pill form.

Side effects of tofacitinib include:

  • Upper respiratory tract infections (colds, sinus infections)
  • Runny nose
  • High cholesterol
  • Headache
  • Anemia

Side effects of upadacitinib include:

  • Headache
  • Fatigue
  • Acne
  • Nausea
  • Urinary tract infections (UTIs)
  • High cholesterol

Ozanimod (Zeposia), an S1P, is another oral medication. Side effects include:

  • Upper respiratory tract infections 
  • Elevated liver enzymes, detected through blood tests
  • Headache
  • Low blood pressure when you go from sitting or lying to standing
  • Changes in breathing

Your needs will depend on your symptoms, and each person is different. Your ulcerative colitis could start out as mild, then stop for a while, only to come back worse than it was before. Or you may have only mild ulcerative colitis your entire life.

Plus, your body may not respond the same way to a drug as someone else's. And over time, you may find that you need a different type of medicine. For example, something that’s worked well for years may not work anymore. You may need a whole new treatment plan.

Let your doctor know how you’re really doing, and always tell them about any side effects that you have.

Finding the right medications to treat ulcerative colitis can be challenging. Sometimes, you have to stop taking one because it causes side effects that are too severe. Other times, you might not respond to the medication. Most UC medications for mild to moderate UC are available by pill, but if the problem is in the lower part of your colon, you might use enemas or suppositories. These deliver the medicine directly to the affected areas. Medications for moderate to severe UC can be pills but there are several given by injection or IV.

What is the best medicine for ulcerative colitis? 

There is no one best medicine to treat ulcerative colitis. If your disease is mild to moderate, your doctor will likely start treatment with a drug in the aminosalicylate group of drugs. If it’s more severe, there are other possible UC medications.

What is the drug of choice for colitis?

The first drug of choice for mild to moderate ulcerative colitis is usually from the aminosalicylate group of drugs. These include balsalazide (Colazal), mesalamine (Apriso, Asacol HD, Delzicol, Lialda, Pentasa, Canasa, Rowasa), olsalazine (Dipentum), and sulfasalazine (Azulfidine)

Is there a pill for ulcerative colitis?

Most ulcerative colitis medications for mild to moderate UC and some for moderate to severe UC come in pill forms.

How do you calm a colitis flare-up?

The most common drugs used to calm flare-ups are corticosteroids.

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