Ulcerative Colitis Medications
The goal of drug therapy with ulcerative colitis is to reduce
the inflammation, induce or maintain remissions,
and improve the quality of life.
Medical treatment of ulcerative colitis will depend on the severity,
the location of the disease. Finding which
the most effective may take time and experimentation.
The following are the most common medications prescribed to treat
Steroids are employed to reduce inflammation and can be used to induce
Prednisone, prednisolone, hydrocortisone, and methylprednisolone are
the most common corticosteroids. These drugs are administered
orally, intravenously, by injection, by enema, or by suppository.
Steroids are sometimes combined
with other medications to reduce symptoms
Patients taking steroids for an extended period of time may need to
take calcium and vitamin D supplements to prevent osteoporosis.
With an ample list of potential side effects your physician will begin
reducing the amount of corticosteroids after the inflammation has
subsided. The reduction in dosage will be done
gradually allowing the body to recover and regulate its own levels of
natural steroids. If the dose is lowered too fast withdrawal
symptoms may occur, including fever, and joint pain.
Prednisone Side Effects to Hate:
- increased rate of infection
- weight gain
- accelerated osteoporosis
- diabetes (type 2)
- cataracts or glaucoma
- menstruation irregularities
- a whole slew of emotional disorders: irritability,
psychosis, and depression
Mesalamine (5-Aminosalicylic Acid): Sulfasalazine
The compound 5-Aminosalicylic Acid (5-ASA) is commonly referred to as
mesalamine, it shares a similar chemical structure to
Mesalamine can be effective for IBD because of its inhibiting factors
of the immune system that causes inflammation.
Sulfasalazine is the standard mesalamine formulation.
Sulfapyridine, a sulfa component, is added to prevent the mesalamine
from being absorbed until it reaches the target inflammation in the
There are other timed release varieties of mesalamine that allows the
medication to target specific regions of the intestines.
Pentasa is coated with ethyl cellulose which allows the drug to be
slowly released from the stomach through the intestines.
Pentasa has been effective in patients when the disease occurs in the
Asacol is coated with an acrylic which delays the release of the
mesalamine until it reaches the last section of the ileum and the colon.
Mesalamine Side Effects to Hate:
Immunosuppressive Drugs (immunomodulator)
Immunosuppressive drugs are used as long term therapies for ulcerative
colitis when the patient does not respond to standard
treatments. By suppressing the actions of the immune system
inflammatory response, immunosuppressive drugs assist in maintaining
The most common examples of immunosuppressive drugs are azathioprine
(AZA), Imuran, 6-mercaptopurine (6-MP) (Purinethol).
It may take 10 to 12 weeks for the drug to begin improving
symptoms. Patients taking immunosuppressive drugs need to be
monitored by regular blood tests to check for effects on bone marrow,
the liver and the kidneys. Because these drugs weaken the
immune system there is an increased risk of infection.
Side Effects to Hate:
- nausea, vomiting and diarrhea
- liver inflammation
Tumor Necrosis Factors (TNF) Modifiers
Infliximab (Remicade) is an antibody or biologic response modifier that
interferes with the body’s inflammatory response.
These drugs target the inflammatory immune factor of a molecule called
tumor necrosis factor or TNF.
Infliximab (Remicade) was approved for treating ulcerative colitis by
the Food and Drug Administration in September 2005.
The first genetically engineered drug approved for ulcerative
colitis, infliximab blocks the activity of tumor necrosis factor-alpha
(TNF-a). It is used when the disease is not responding to
other medications. Infliximab has been successful in inducing
remission in up to 80% of patients after one
Infliximab is administered intravenously by your GI or other licensed
health care professional. This drug decreases the
effectiveness of the body’s immune system which exposes the
patient to an increase risk of bacterial infection.
There may be an increase risk of lymphoma or cancer of the lymph
glands. Studies are currently being conducted to determine
the link between taking infliximab and lymphoma.
Infliximab (Remicade) Side Effects to Hate:
- nausea, fever, dizziness, chills
- low blood pressure
- labored breathing
- pruritus (sensation of itching)
Budesonide (Entocort EC) is a relatively new corticosteroid used to
treat IBD. It targets the intestinal tract and causes fewer
side effects than other corticosteroids like prednisone.
Budesonide may be effective in treating mild ulcerative
Cyclosporine is an immunosuppresive drug that may be used when a
patient does not respond to mesalamine or corticosteroids.
Nicotine has shown in early studies that symptoms improved in some
people. Some studies have shown that using a nicotine patch
provide some short term relief from ulcerative colitis. How
nicotine relives symptoms isn't known but some doctors suggest it could
protect the colon by thickening and increasing amount of mucus.
It may also play a role in reducing inflammation.