At first, the goal of treatment with medication will be to reduce the severity and frequency of your symptoms. There are five main classes of drugs used to treat ulcerative colitis.
Mesalamine (Lialda, Apriso, Canasa, Pentasa, Asacol)Sulfasalazine (Azulfidine)Olsalazine (Dipentum)Balsalazide (Colazal)
Mesalamine is typically one of the first drugs prescribed for mild to moderate ulcerative colitis. Mesalamine and other aminosalicylates may be taken orally as a tablet or capsule, or rectally, as a suppository or in an enema. Depending on the formulation, it may be necessary to take three or four doses of the drug daily. For ulcerative proctitis — when the disease is confined to your rectum — your doctor may prescribe the suppository formulation alone. Steroids may be taken orally or rectally, and include the following drugs:
BudesonidePrednisoneHydrocortisone (Cortef)Methylprednisolone (Medrol)
Prednisone, hydrocortisone, and methylprednisolone work by suppressing the entire immune system, rather than targeting specific inflammatory pathways. If you take corticosteroids orally or by injection, you may have significant side effects. Local steroids — which are applied just to the area that needs treatment — are generally the preferred option. Steroids are ineffective as maintenance therapy to keep ulcerative colitis in remission. According to Mayo Clinic, possible side effects of steroids include:
InfectionWeight gainHigh blood sugarMood, memory, or behavioral problemsAcneIncreased hair growth on the body and faceHigh blood pressureOsteoporosis
3. Immunomodulators
Also known as immunosuppressants, these drugs work by limiting inflammation at its source in the immune system. Immunomodulators may take several months to start working. They include the following drugs:
Cyclosporine (Gengraf, Neoral, SandIMMUNE)Azathioprine (Azasan, Imuran)Mercaptopurine (Purinethol, Purixan)
Before you begin a course of treatment using an immunomodulator, it’s important to have a recent complete blood count (CBC) and continue periodic monitoring of your blood levels and chemistry while taking the drug.
4. Biologics
Biologics act against a protein that’s part of your immune system response. Some biologics are also tumor necrosis factor (TNF) inhibitors. Biologics include the following drugs:
Infliximab (Remicade)Adalimumab (Humira) Golimumab (Simponi)Vedolizumab (Entyvio)Ustekinumab (Stelara)
5. Small Molecules
Small molecules are oral medications that also work on the immune system, but act differently from biologics. Janus kinase (JAK) inhibitors like tofacitinib (Xeljanz) and upadacitinib (Rinvoq) suppress the immune system by blocking the JAK enzyme, thereby preventing it from activating specific cells that cause inflammation. Ozanimod (Zeposia) is an oral small molecule medication taken once daily for adults with moderately to severely active ulcerative colitis. It’s the first in a class of drugs known as sphingosine 1-phosphate receptor modulators. The exact way Zeposia works is unknown, but the drug is thought to act on lymphocytes, which are immune cells responsible for causing inflammation in the intestines. The drug binds to receptors on the surface of the cells, helping prevent them from moving into the colon and causing damaging inflammation.
Other Medication
Your doctor may prescribe or recommend these other drugs and supplements to help treat ulcerative colitis. Pain relievers Your doctor may recommend acetaminophen (Tylenol) for mild pain. Avoid ibuprofen (Advil or Motrin), naproxen (Aleve), and diclofenac (Voltaren), which can cause digestive upset and worsen ulcerative colitis symptoms. Additional reporting by Ashley Welch.
