When you have ulcerative colitis (UC), you’ll definitely take medicine to help manage it. There are several kinds your doctor will consider, depending on what you need. Because UC is an immune system disease, many of the drugs that treat it are meant to tame inflammation or stop the immune system from mistakenly attacking your gut.
Over-the-Counter (OTC) Drugs
Over-the-counter drugs, which don’t require a prescription, can be helpful.
Medicines for diarrhea and the pain reliever acetaminophen are commonly used to help ease these symptoms. But some OTC pain relievers, such as ibuprofen, can make you feel worse. Always check with your doctor before you use any OTC medications for ulcerative colitis. They may have a bad reaction with medications you’re already taking. They can also raise your risk of complications.
If you often have bleeding related to your ulcerative colitis, you’re more likely to get anemia, which means you’re low on iron because of the blood loss. Check with your doctor to see if you may need iron supplements. But don’t take them without your doctor’s go-ahead.
Drugs That Target Inflammation
Most people with UC take prescription drugs called aminosalicylates (or “5-ASAs”) that tame inflammation in the gut. These include balsalazide (Colazal), mesalamine (Asacol HD, Delzicol), olsalazine (Dipentum), and sulfasalazine (Azulfidine). Which one you take, and whether it is taken by mouth or as an enema or suppository, depend on the area of your colon that's affected. As long as you avoid your triggers, these may be enough if your disease is mild to moderate.
You may need something else if your condition is more severe or if those standard treatments stop working. Your doctor may consider other medicines. Some people may also need surgery.
Meds to Stop a Flare
Corticosteroids -- which your doctor may refer to as budesonide, hydrocortisone, methylprednisolone, or prednisone -- are often called “steroids” for short. They aren’t the kind of steroids some people misuse to gain muscle, so you won’t bulk up.
These turn down your immune system to fight inflammation. You can take them as pills, through an IV, or with an enema or suppositories.
Your doctor may prescribe these to get you through a flare. But steroids aren’t a long-term solution because they can cause side effects like:
They also don’t prevent future flares. So it’s best to use them only for a short time and at the lowest dose that helps.
More Drugs That Work on Your Immune System
Other types of medicines for ulcerative colitis target your immune system, too. Your doctor may call these immunomodulators. They may be good options if 5-ASAs and corticosteroids haven’t worked well for you.
The most common ones are azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), and cyclosporine (Gengraf, Neoral, and Sandimmune). 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.
Ozanimod (Zeposia) is an oral medication and is the first sphingosine 1-phosphate (S1P) receptor modulator approved for patients with moderately to severely active UC.
The goal is to lower inflammation in your colon.
These drugs can have side effects. They can damage your liver and make you more likely to get skin cancers, lymphoma, and infections. If you take them, 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. The drug may cause kidney problems, gout, infections, and 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, like a low dose of a corticosteroid, to help in the meantime.
“Biologic” drugs also work on the immune system, but in a different way. They have very specific targets instead of the whole immune system. Some are taken in pill form. Others are taken as shots or suppositories. You may use some medicines as an enema or rectal foam, which is similar to an enema. Rectal foam is especially helpful in treating inflammation of the large intestine.
Many biologics for ulcerative colitis pinpoint tumor necrosis factor (TNF), which causes inflammation. Your doctor may call these “anti-TNF” drugs. They include adalimumab (Humira) and biosimilar drugs adalimumab-adbm (Cyltezo) and adalimumab-atto (Amjevita); golimumab (Simponi); infliximab (Remicade) and biosimilars infliximab-abda (Renflexis) and infliximab-dyyb (Inflectra). Other biologics include ustekinumab (an anti-interleukin 12/23 antibody) and vedolizumab (Entyvio, an anti-integrin antibody). Your doctor can give them to you in a shot or through an IV.
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 type of medication targets Janus kinase enzymes. These enzymes help control chemical messengers involved in your body’s immune response. Tofacitinib (Xeljanz) treats adults with moderately to severely active UC.
What Will You Need?
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.