Ulcerative Colitis medications & treatments
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Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects close to 1 million people in the United States. It is a chronic condition whose symptoms gradually develop over time. You are more likely to develop ulcerative colitis between the ages of 15 to 30 or if you have a family member with IBD. There is no cure for ulcerative colitis but there are treatments and lifestyle changes that can help effectively manage symptoms and improve your quality of life.
What is ulcerative colitis?
Ulcerative colitis causes inflammation and ulcers in the innermost lining of your large intestine (colon) and rectum. The inflammation usually starts in the rectum and can spread to the colon. If it affects only the rectum, it is called ulcerative proctitis. If the entire colon is affected, it is called pancolitis.
The exact cause of ulcerative colitis is unknown, but research suggests that it is the result of an overactive immune system. There seems to be a genetic link to developing ulcerative colitis as well as environmental factors.
Some other risk factors include:
- Age between 15 and 30, or older than 60.
- Jewish decent
- Frequent use of NSAIDs including Advil (ibuprofen) and Aleve (naproxen).
When you develop ulcerative colitis, your symptoms start gradually and get worse over time. Some symptoms of ulcerative colitis you may experience include:
- Bloody diarrhea
- Abdominal pain
- Abdominal cramping
- Rectal bleeding
- Urgency to have bowel movements
- Inability to defecate despite the increased urgency
- Loss of appetite
- Weight loss
How is ulcerative colitis diagnosed?
For the diagnosis of ulcerative colitis, your healthcare professional will assess your symptoms, review your medical and family history, and perform some diagnostic tests. Some of these tests include:
- Blood tests. These look for signs of infection as well as anemia, which can indicate bleeding from the colon or rectum.
- Stool samples. This will check for inflammation, as well as white blood cells, bacteria, viruses, or parasites.
- Colonoscopy. A doctor will use a thin, flexible, lighted tube with a camera to examine your entire colon. They will look for signs of inflammation and how much of the colon is affected.
- Flexible sigmoidoscopy. Similar to a colonoscopy, it is used to examine the rectum and the lower part of the colon for signs of inflammation.
- Biopsy. During a colonoscopy or sigmoidoscopy, a small tissue sample is taken and examined by a laboratory for a definitive diagnosis of ulcerative colitis. It can also be used to screen for colorectal cancer.
- Imaging tests. You may be asked to get an x-ray or CT scan if you have severe ulcerative colitis or your doctor suspects that you may have a complication such as a perforation.
What are some ulcerative colitis treatment options?
Treatment will depend on the individual and the severity of your symptoms. The main goal for ulcerative colitis is to reduce inflammation. This will help prevent flare-ups and lead to a longer time in remission. Your primary care doctor or gastroenterologist will develop a treatment plan specifically for you which can include medications, surgery, and diet or nutritional changes.
Medications are the first-line treatment for ulcerative colitis. Your doctor may recommend:
- 5-aminosalicylates. These are usually prescribed for mild symptoms of ulcerative colitis and include Azulfidine (sulfasalazine), Asacol HD (mesalamine), Colazal (balsalazide), and Dipentum (olsalazine). They can be taken orally or rectally with a suppository or enema.
- Corticosteroids. These are typically given if you did not respond to aminosalicylates and include Deltasone (prednisone) and Uceris (budesonide). Due to potential side effects, these meds are not recommended for long-term use.
- Immunosuppressants/Immunomodulators. Used after failing aminosalicylates and corticosteroids, these medications reduce inflammation by suppressing the immune system response. Examples include Purinethol (mercaptopurine), Imuran (azathioprine), Sandimmune (cyclosporine), and Xeljanz (tofacitinib).
- Biologics. These monoclonal antibodies are used to treat moderate to severe symptoms of ulcerative colitis by targeting a protein made by the immune system to reduce swelling and inflammation. These include Humira (adalimumab), Remicade (infliximab), Entyvio (vedolizumab), and Stelara (ustekinumab).
- Probiotics. Though not used to calm active flare-ups, probiotics containing Lactobacillus can help maintain or prolong remission.
If you have a case of ulcerative colitis that does not respond to medications or are suffering from complications such as severe rectal bleeding, colon cancer, perforation, or swelling of the colon (toxic megacolon), surgery is indicated. This involves the removal of part of or all of your colon and your rectum (proctocolectomy). It can happen in up to one-third of patients with ulcerative colitis.
Most cases involve a procedure called J-pouch surgery. This procedure does not require you to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine and attaches it directly to your anus, allowing you to pass waste relatively normally.
In some cases, your surgeon will create a permanent opening in your abdomen (ileostomy) through which stool is passed to an attached bag to be collected.
What is the best medication for ulcerative colitis?
The best medication for the treatment of ulcerative colitis will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with ulcerative colitis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter ulcerative colitis medications approved by the Food and Drug Administration (FDA).
Best medications for ulcerative 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 (mesalamine)||5-ASA||Oral||1.5g 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)||Immunosuppresant||Oral||1.5mg/kg to 3mg/kg once daily.||Bone marrow suppression, abdominal pain
|Purinethol (mercaptopurine)||Immunosuppresant||Oral||1mg/kg to 1.5mg/kg at bedtime.||Nausea, vomiting, abdominal pain
|Xeljanz (tofacitinib)||JAK1 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 correct 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 ulcerative colitis medications?
As with all medicines, those used for ulcerative colitis will have some side effects, depending on the class you are taking.
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 ulcerative colitis?
Along with medications, some lifestyle changes and changes to your diet can help with symptom control and increase remission time. Some recommended changes include:
- 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 through exercise, meditation, and biofeedback. Also, maintain a good sleep routine.
Frequently asked questions about ulcerative colitis
How common is ulcerative colitis and who gets it?
Ulcerative colitis affects an estimated 1 million people in the United States. It evenly affects males and females. It seems to be more common in cities rather than rural areas. It is more commonly diagnosed in those aged 15-30 and is found more in Caucasians, especially those of Jewish descent.
What is the difference between ulcerative colitis and Crohn’s disease?
They are both inflammatory bowel diseases and share some of the same symptoms such as stomach cramps and pain, diarrhea, reduced appetite, and fever. Ulcerative colitis, however, only occurs in the large intestine while Crohn’s disease can occur at any point in the gastrointestinal tract. Ulcerative colitis also only affects the innermost lining of the colon while Crohn’s disease can occur in all the layers of the bowel walls.
What foods and drinks should I avoid with ulcerative colitis?
Although your diet will not be the cause of your ulcerative colitis, there are certain foods and drinks to avoid that may trigger or worsen a flare-up, such as:
- Greasy, fatty foods
- High-fiber foods
- Spicy foods
- Drinks high in sugar or fructose
What medications should I avoid with ulcerative colitis?
Some medications can trigger or worsen your symptoms including nonsteroidal anti-inflammatory drugs such as Advil (ibuprofen), Aleve (naproxen sodium), and aspirin. There are certain circumstances where antibiotics can also worsen symptoms.
What are some complications of ulcerative colitis?
Ulcerative colitis can be managed but can also have some serious complications. These long-term effects include:
- Increased risk of colon cancer
- Severe bleeding
- Osteoporosis (bone loss)
- Inflammation of your skin, joints, and eyes
- Kidney stones
- Perforation of your colon
Related resources for ulcerative 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.