Managing Ulcerative Colitis: Medicines

Your healthcare provider may give you medicine to help control your ulcerative colitis. Medicine can help lessen symptoms. It won’t cure ulcerative colitis. But it can help improve your quality of life. Work closely with your healthcare provider. You may have certain side effects or your symptoms may change. In this case, your medicine or dosage may need to be changed.

Types of medicines

You may be prescribed any of these types of medicines:

• Anti-inflammatories

• Corticosteroids

• Immunomodulators

• Biologic agents

• Antibiotics

• Probiotics

• Small-molecule medicines

You can learn more about each kind below.

Anti-inflammatories

These medicines can reduce inflammation and pain in the lining of the intestines. The most common ones for ulcerative colitis are 5-ASA compounds, such as sulfasalazine and mesalamine. These help control symptoms over long periods of time. They may be taken as pills. But they also can be taken as an enema or suppository put directly into the rectum.

Corticosteroids

Your healthcare provider may advise you to take corticosteroids. These help to calm inflammation in your body. This can make your symptoms better quickly. You may take corticosteroids as a pill or liquid by mouth. In some cases, they may be given through an intravenous line (IV). Or they may be given rectally as either a suppository or an enema. You take them for a short time, usually not longer than 8 to 12 weeks. You don't take them when you are in remission. Remission is a long period with no symptoms.

If used for a long time, side effects may include:

• Mood changes

• Trouble sleeping

• Changes in body shape

• Puffy face or acne

• Weight gain

• Stretch marks

• Eye problems

• Bone loss or breaks

• Facial hair in women

• High blood pressure

• Risk of diabetes

Immunomodulators

These medicines cause your body's immune system to be less active. This can help reduce inflammation and calm your symptoms. They are taken as a pill by mouth. You may not feel their effects until you have taken them for a few months. But you can take them for a long time. You will need to have blood tests every few months to check your liver and blood cell counts. 

Side effects may include:

• Nausea

• Body aches

• Inflammation of the pancreas

• Low white blood cell count

• Liver problems

• Low folic acid levels

• Infection

• Lymphoma

• Non-melanoma skin cancer

Biologic agents

These kinds of medicines help stop body chemicals that cause inflammation. One medicine is called infliximab. It is an antibody that blocks tumor necrosis factor (TNF). TNF is a chemical that plays a major role in inflammation in the intestines. Vedolizumab is another medicine. It's an antibody that blocks white blood cells from getting into the intestinal tissue and causing inflammation. 

New biologics are also being made. They target different ways the intestine gets inflamed in ulcerative colitis. These medicines may be given different ways. They may be given by vein (IV) every 2 to 8 weeks. They may be given with a shot (injection) once a week or once a month. These medicines can put you at risk for infections. Tell your healthcare provider if you have a chronic infection. You will need to be tested for tuberculosis and hepatitis B infection before taking the medicine.

Side effects may include:

• Flushing, chest pain, shortness of breath, hives, or a drop in blood pressure during IV treatment

• Joint and muscle aches

• Rash

• Fever

• Infection

• Lymphoma

• Skin cancers

• Liver toxicity

• TNF-induced psoriasis

Small molecule medicines

New medicines called small molecules are now available to treat ulcerative colitis. They are taken by mouth. Speak with your provider to see if they are right for you.

Antibiotics

Antibiotics are not used to treat ulcerative colitis, but are used to treat some complications that may arise. These may be used if you also have an infection, such as an abscess. Antibiotics may be given as a pill taken by mouth. Or sometimes they are put into a vein (IV) for more serious infections. Depending on the antibiotic, you may need to stay out of the sun. Or you may need to not drink alcohol.

Antibiotics may be of great help. But they also may cause severe reactions. These can include nausea, vomiting, and breathing problems. Tell your healthcare provider right away if you have numbness or tingling in your hands. Also tell your healthcare provider if your bowel symptoms become worse.

Side effects may include:

• Nausea

• Diarrhea

• Headaches

• Dizziness

• Dark urine

• Loss of appetite

• Metallic taste in the mouth

• Sensitivity to the sun

Probiotics

Probiotics are living organisms good for health. You can take them in a supplement. They may help some cases of ulcerative colitis. But research studies are not clear if there is a benefit. Talk with your healthcare provider to learn more. before taking probiotics, especially if you are on immunosuppressive medicines.

Managing side effects

Your healthcare provider will talk with you about the side effects of any new medicines and when they should be reported. In most cases, side effects are easy to manage. But sometimes they can be so severe that you need to change medicine. Call your healthcare provider if you have:

• Side effects that are hard to handle

• Severe side effects

• Unexpected side effects