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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 medications are the most effective may take time and experimentation.

The following are the most common medications prescribed to treat ulcerative colitis.

Corticosteroids

Steroids are employed to reduce inflammation and can be used to induce remission. 

Prednisone, prednisolone, hydrocortisone, and methylprednisolone are the most common corticosteroids.  These drugs are administered orally, intravenously, by injection, by enema, or by suppository.

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
• acne
• hypertension
• accelerated osteoporosis
• diabetes (type 2)
• cataracts or glaucoma
• menstruation irregularities
• a whole slew of emotional disorders: irritability, insomnia, 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 aspirin.  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 colon.

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 small intestines.

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:

• diarrhea
• nausea
• cramping

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 and its inflammatory response, immunosuppressive drugs assist in maintaining remission.

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
• rash
• malaise
• 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 infusion.  

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
• headaches
• rash
• hives
• low blood pressure
• labored breathing
• pruritus (sensation of itching)

Future Therapies

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 colitis.

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 may 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.