Colitis medications & treatments
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Colitis is a chronic digestive disease that causes inflammation in the colon, which is the longest part of your large intestine. It typically occurs in people aged 15-35 or 55-70. Colitis has numerous causes including infection, so symptoms can be resolved if the underlying cause is successfully treated. In some cases such as ulcerative colitis, it can be a chronic, life-long condition with no cure. There are, however, treatment options to help manage this condition.
What is colitis?
Colitis is characterized by the inflammation and swelling of the inner lining of the colon. It can have a tremendous impact on your quality of life if you suffer from this condition.
There are different types of colitis, and the symptoms will vary depending on what type you have. Some common symptoms of colitis include:
- Abdominal pain
- Watery diarrhea
- Blood in your stool
- Urgent need to have a bowel movement
- Unexpected weight loss
The type of colitis depends on the cause and is categorized into the following:
- Infectious colitis. Infections are the most common cause of colitis. While several bacteria and parasites can cause colitis, Clostridium difficile can cause a severe type called pseudomembranous colitis. C. diff is a bacteria that is always present in your body but it’s usually balanced out by your “good” bacteria. Certain medications, typically antibiotics, can destroy your good bacteria, and allow C. diff to increase which can cause inflammation in your colon. Symptoms include watery diarrhea, abdominal pain, and vomiting.
- Inflammatory bowel disease. Ulcerative colitis (UC) and Crohn’s disease are both types of inflammatory bowel diseases (IBD). UC can affect any part of your gastrointestinal tract from your colon to your rectum, while Crohn’s disease only affects your colon. UC is the most common type of diagnosed colitis. Symptoms include diarrhea, weight loss, and abdominal pain.
- Ischemic colitis. This type is due to reduced or blocked blood flow to the colon. It is usually caused by an underlying condition such as heart disease, blood clots, and plaque build-up. Symptoms can include bloody stools, diarrhea, abdominal pain, and abdominal cramps.
- Microscopic colitis. Lymphocytic colitis and collagenous colitis are examples of this type of colitis that are diagnosed by looking at a tissue sample from the colon under a microscope. A higher number of lymphocytes (white blood cells) will be present in the lymphocytic type but the colon lining will be at its normal thickness. In the collagenous type, the lining will be thicker due to a build-up of collagen under its outermost layer. Symptoms include watery diarrhea, weight loss, abdominal pain, and cramping.
How is colitis diagnosed?
Your healthcare provider may ask about the frequency and severity of your symptoms. They may also perform a physical exam as well as the following tests:
- Blood tests and stool cultures. This is to confirm or rule out bacteria or parasites as the cause. They may also check for certain enzymes that could indicate the specific form of colitis you have to treat effectively.
- Colonoscopy and sigmoidoscopy. Colonoscopy involves using a thin, flexible tube to view the rectum and the colon. Sigmoidoscopy is similar but is used to view the rectum and the lower part of the colon. A gastroenterologist will use these to look for any inflammation and damage.
- Abdominal imaging. X-rays, CT scans, and MRIs can be used to rule out other conditions and to access the extent of the disease. An x-ray is usually done after a barium enema, which helps make the images more visible.
- Biopsy. A sample is usually taken during a colonoscopy and then examined under a microscope to look for changes due to inflammation and to help determine the cause of your colitis.
What are some colitis treatment options?
Treatment is based on the type of colitis and the underlying cause. The goal is to help reduce or relieve symptoms. You may be prescribed one or more of the following:
- Antibiotics to treat an underlying infection. These will depend on which bacteria or parasite is present and can include Flagyl (metronidazole) or vancomycin.
- Antidiarrheals to reduce the frequency of your bowel movements. This can include Pepto Bismol (bismuth subsalicylate) and Imodium A-D (loperamide).
- Anti-inflammatory medications to reduce swelling and pain. 5-aminosalicylates (5-ASA) are the first-line treatments and include Apriso (mesalamine), and Azulfidine (sulfasalazine). Corticosteroids such as Deltasone (prednisone) can be used as a short-term treatment to quickly help with symptoms during a flare-up. They are given as an oral tablet or a suppository.
- Immunosuppressants or immunomodulators are typically used when other medications have failed. These include medications used to calm your overactive immune system such as Xeljanz (tofacitinib), Imuran (azathioprine), Purinethol (mercaptopurine), or Sandimmune (cyclosporine).
- Biologics are typically injections used after multiple other medications have failed. These include monoclonal antibody medications, such as Remicade (infliximab), Humira (adalimumab), and Stelara (ustekinumab).
- Surgery such as a colectomy is used in cases of severe ulcerative colitis that have not responded to treatment. This involves removing the entire colon and then using your small intestine to pass waste out of your body using an ileostomy bag.
What is the best medication for colitis?
The best medication for colitis will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with colitis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare professional about the best medication for you. The table below includes a list of the most prescribed or over-the-counter colitis medications approved by the Food and Drug Administration (FDA).
Best medications for colitis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects
|Humira (adalimumab)||TNF inhibitor||Injection||160mg under the skin, on day 1, then 80mg 2 weeks later, then 40mg every 2 weeks as maintenance.||Injection site reactions, upper respiratory infection, headache, rash
|Remicade (infliximab)||TNF inhibitor||Injection||5mg/kg IV infusion at 0, 2, and 6 weeks, then every 8 weeks thereafter.||Infection, nausea, abdominal pain, headache, infusion site reaction
|Simponi (golimumab)||TNF inhibitor||Injection||200mg under the skin to start, 100mg at week 2, then 100mg every 4 weeks thereafter.||Upper respiratory tract infection, injection site reactions, viral infections
|Entyvio (vedolizumab)||Integrin blocker||Injection||300mg IV infusion at 0, 2, and 6 weeks, then every 8 weeks thereafter.||Common cold, headache, joint pain
|Stelara (ustekinumab)||Interleukin inhibitor||Injection||Initial weight-based IV infusion, then 90mg under the skin every 8 weeks thereafter.||Upper respiratory tract infection, injection site reaction, headache
|Apriso/Asacol (mesalamine)||5-ASA||Oral||1.5gm daily in the morning.||Abdominal pain, headache, gas, nausea
|Colazal (balsalazide)||5-ASA||Oral||2.25g three times daily for 8 to 12 weeks.||Headache, abdominal pain, nausea
|Imuran (azathioprine)||Immunosuppressant||Oral||1.5mg/kg to 3mg/kg once daily.||Bone marrow suppression, abdominal pain
|Purinethol (mercaptopurine)||Immunosuppressant||Oral||1mg/kg to 1.5mg/kg at bedtime.||Nausea, vomiting, abdominal pain
|Xeljanz (tofacitinib)||JAK inhibitor||Oral||10mg twice daily for at least 8 weeks, then 5mg to 10mg twice daily thereafter.||Common cold, elevated cholesterol levels, headache
|Uceris (budesonide)||Corticosteroid||Oral||9mg every morning for up to 8 weeks.||Headache, acne, nausea
Your healthcare provider will determine the proper dosage for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of colitis medications?
As with all medicines, those used for colitis will have some side effects, depending on the class you are taking.
For antidiarrheals, the most common side effects are abdominal pain and constipation.
Corticosteroids may cause weight gain, mood changes, acne, increased blood sugar, and increased blood pressure.
Aminosalicylates should not be taken if you are allergic to aspirin. They may also cause abdominal pain, headache, gas, and nausea.
Immunosuppressants can suppress the immune system so you can see an increased risk of infection as well as cancer. Some other side effects include nausea, vomiting, and abdominal pain.
Biologics are given by injections so you may see injection site reactions. They also carry an increased risk of infections, cancer, and allergic reactions.
What are some home remedies for colitis?
In addition to prescribed medications, some self-care home remedies can help reduce or relieve symptoms, including:
- Replace fluids. Since diarrhea is one of the most common symptoms of colitis, it is important to avoid dehydration by drinking plenty of clear fluids with electrolytes.
- Avoid foods and drinks that may trigger flare-ups. While these affect everyone differently, the foods that most commonly cause symptoms are foods high in fiber, spicy foods, dairy if you’re lactose intolerant, caffeine, and alcohol.
- Stop smoking.
- Eat small, nutritious meals. Small, healthy meals can help correct any nutritional deficiencies and prevent complications such as anemia and malnutrition.
- Take multivitamins or other dietary supplements. Some types of colitis can interfere with your ability to absorb nutrients such as proteins, carbohydrates, water, vitamins, and minerals. And since your diet may be limited, multivitamins and supplements can be helpful to replenish some of these nutrients.
- Reduce stress and maintain a good sleep routine.
Frequently asked questions about colitis
What’s the fastest way to stop a flare-up?
The fastest way to stop a flare-up is through medications such as corticosteroids or aminosalicylates. A change in diet may help for certain types of colitis as well.
What are some complications of colitis?
Since colitis can be a chronic condition there are some serious complications you can have. These include rectal bleeding, increased risk of colon cancer, increased risk of colorectal cancer, and perforation (hole) of your colon.
What medications should I avoid if I have colitis?
Medications to avoid can depend on which type of colitis you have or what the underlying cause is. There are meds, however, that may cause or worsen colitis and should be avoided. These include nonsteroidal anti-inflammatory drugs (NSAIDs), potassium chloride, cimetidine, proton pump inhibitors, and carbamazepine.
What foods or drinks should I avoid if I have colitis?
Certain foods and drinks may trigger a flare-up or make it worse and should be avoided. These include caffeine, alcohol, dairy products, high-fiber foods, spicy foods, and fried foods.
Can colitis be cured?
If colitis is due to an underlying condition such as an infection, then once you treat the infection, the colitis resolves. Other causes can be long-term and flare-ups can happen throughout a lifetime without it ever being completely resolved.
Related resources for colitis
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.