What Are Ulcerative Colitis Medications?
Ulcerative colitis (UC) medications help you manage the symptoms and progression of ulcerative colitis. Because UC affects your autoimmune system, the drugs that treat it are meant to lower inflammation or stop your immune system from mistakenly attacking your gut.
Medications are the standard treatment for ulcerative colitis, but some people need to try different UC medications or a combination of them before they start to feel better. There are several major classes (groups) of prescription medications that doctors use to treat the disease and manage flare-ups.
Over-the-Counter Medicines for Ulcerative Colitis
Over-the-counter (OTC) drugs can be helpful when you’re not feeling well. That said, these drugs are still medications and should be used with caution.
Be sure to follow the instructions and always check with your doctor before you use any OTC medications for ulcerative colitis. They may interact with medications you’re already taking, which can lead to bad reactions and raise your risk of complications.
If you take any prescription medications, check with your pharmacist to see it’s safe for you to use OTC products. You might use OTC drugs for:
Diarrhea. Many people with ulcerative colitis get diarrhea. If you want to use an OTC product, such as loperamide (Imodium A-D) to manage severe diarrhea, it’s important to speak with your doctor first. Anti-diarrhea medications can cause a serious complication called toxic megacolon.
Pain. If you have pain, your doctor may suggest acetaminophen. Be careful when taking OTC pain relievers such as diclofenac sodium (Voltaren), ibuprofen, and naproxen, as they can worsen your symptoms and make your disease more severe.
Supplements for ulcerative colitis
Some supplements on the market might help you manage your ulcerative colitis or the effects it has on your body.
Bleeding. If you often have bleeding related to your ulcerative colitis, the blood loss can result in low iron in your blood. This can lead to anemia. You might need iron supplements, but check with your doctor first because there are different types and doses of supplements. Don’t take them without your doctor’s go-ahead.
Spasms. If you get painful spasms, peppermint oil capsules might help.
Your doctor might also recommend other supplements, such as:
- Calcium
- Folic acid
- Vitamin B12
- Vitamins A, D, E, and K
- Zinc
Most Common Ulcerative Colitis Medications
Doctors prescribe ulcerative colitis medications that target inflammation because if you can reduce your gut inflammation, you might be able to control the symptoms.
Aminosalicylates (5-ASA)
Most people with mild to moderate UC take a class of prescription medications called aminosalicylates (also known as 5-ASAs or mesalamines). These work to reduce inflammation in your gut, putting you into remission and hopefully keeping you there.
Aminosalicylates include:
- Balsalazide (Colazal)
- Mesalamine (Apriso, Asacol HD, Canasa, Delzicol, Lialda, Pentasa, Rowasa)
- Olsalazine (Dipentum)
- Sulfasalazine (Azulfidine)
“5-ASAs are typically the first-line therapy for mild to moderate ulcerative colitis, but they’re also less powerful than other medications used to treat the condition,” says Ronen Arai, MD, a gastroenterologist with Baptist Health South Florida.
He says this type of ulcerative colitis medication might not work well for people with serious symptoms who need stronger treatments.
“There’s no evidence that one type of 5-ASA works better than another,” Arai says. “What really makes a difference is the total amount you take each day.” Keep in mind that your doctor will decide the right dose for you, based on what your body needs.
Which one you take, and whether it’s taken by mouth or as an enema or suppository, depends on the area of your colon that's affected and how severe your illness is. If the inflammation is in your rectum, suppositories are usually better than pills. Suppositories deliver the medications directly to the area. Some people take both suppositories and pills. Enemas go higher in the colon to deliver the medication. If you have left-sided colon inflammation, you might benefit from this.
You might need other medications if your condition is more severe or if the standard treatments stop working. Some people may also need surgery.
Most people tolerate these drugs well, but there can be side effects. The most common ones include:
- Headache
- Nausea
- Abdominal (belly) pain and cramping
- Loss of appetite
- Vomiting
- Rash
- Fever
Corticosteroids
If you have severe ulcerative colitis symptoms, your doctor may recommend corticosteroids, also called glucocorticoids. They’re often called “steroids” for short. They aren’t the kind of steroids some people misuse to gain muscle, so you won’t bulk up.
Corticosteroids turn down your immune system to fight inflammation. You can take them as pills, through an IV, or with an enema or suppositories.
These medications include:
- Budesonide (Enterocort, Tarpeyo, UCERIS)
- Hydrocortisone (Colocort, Cortenema, Cortifoam, Proctocort)
- Methylprednisolone (Depo-Medrol, Medrol Dosepak, Solu-Medrol)
- Prednisolone (Flo-Pred, Orapred, Pediapred)
- Prednisone
“Steroids are often used early in the course of ulcerative colitis to quickly manage troublesome symptoms like rectal bleeding, diarrhea, and urgency – especially while waiting for other treatments to take effect,” says Arai. “They may also be used during flares when symptoms need fast control."
Corticosteroids can cause side effects, especially with long-term use. That’s why doctors usually limit how long you take them. Possible side effects include:
- Weight gain, especially around the face and belly
- Acne
- High blood pressure
- High blood sugar
- Mood swings
- Bone loss
- Upset stomach
- Weakened immune system, putting you at risk of infections
- Glaucoma
- Cataracts
- Osteoporosis (thinning of the bones)
- Fatigue
- Easy bruising
- Slow wound healing
Ulcerative Colitis Medications to Stop a Flare
Aminosalicylates and corticosteroids are also used to treat ulcerative colitis flare-ups. Flare-ups happen when UC symptoms that were previously under control come back for some reason.
UC Medicines That Target the Immune System
Other types of medicines for ulcerative colitis target your immune system to get your symptoms under control.
Immunomodulators
These may be a good option if 5-ASAs and corticosteroids haven’t worked well for you.
They include:
- Azathioprine (Azasan, Imuran)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
- Mercaptopurine (Purinethol, Purixan)
- Tacrolimus (Astagraf XL, Envarsus XR, Prograf)
“Immunomodulators can take several weeks to start working, so they’re often used alongside steroids,” Arai says. “Steroids help bring on remission quickly, and then we gradually taper them off as the immunomodulator begins to take effect over time – usually over the course of weeks to months.”
Due to the risk of side effects, doctors usually save cyclosporine for people who don’t have success with other meds. They may also try methotrexate paired with folic acid.
These drugs can also have side effects. They can cause:
- Liver damage
- Skin cancers
- Lymphoma
- Weakened immune system, increasing your risk of infections
If you take these immunomodulators, your doctor will test your blood and check you for skin cancer regularly.
Cyclosporine is especially strong, but it works fast. Your doctor might prescribe it to get a severe flare under control, and then give you 6-MP or azathioprine afterward. Side effects can include:
- Kidney problems
- Gout
- Lowered immune system
- High blood pressure
It can take several months for some of these drugs to work. So your doctor may give you a faster-acting medicine, such as a low dose of a corticosteroid, to help in the meantime.
Biologics for Ulcerative Colitis
Another class of drugs to treat UC is called biologics, and they're usually given to people with moderate to severe disease. They can be used with other medications as well. They reduce inflammation and help the colon wall to heal. Most of these medications are given through an IV, but some are given by injection. Examples of biologics are:
- Adalimumab (Humira)
- Adalimumab biosimilar (Amjevita)
- Golimumab (Simponi)
- Guselkumab (Tremfya)
- Infliximab (Remicade)
- Infliximab biosimilars (Inflectra, Renflexis, Avsola)
- Mirikizumab (Omvoh)
- Risankizumab-rzaa (Skyrizi)
- Ustekinumab (Imuldosa, Otulfi, Pyzchiva, Selarsdi, Stelara, Wezlana)
- Vedolizumab (Entyvio)
Biologics side effects
Biologics don’t have as many side effects as some other ulcerative colitis drugs, but they can cause:
- A weakened immune system
- Allergic reactions
- Irritation where the needle went in
When you take biologics, you're more likely to get tuberculosis, fungal infections, certain kinds of cancers, and other conditions. Your doctor will check for tuberculosis and other infections before prescribing one of these medications and keep a close watch on how you're doing while you take them.
Targeted Small Molecule Medications
This group of ulcerative colitis medications also targets the immune system. Some are sphingosine l-phosphate (S1P) receptor modulators and others are Janus kinase (JAK) inhibitors.
Tofacitinib (Xeljanz) and upadacitinib (Rinvoq) are JAK inhibitors that you take in pill form.
Side effects of tofacitinib include:
- Upper respiratory tract infections (colds, sinus infections)
- Runny nose
- High cholesterol
- Headache
- Anemia
Side effects of upadacitinib include:
- Headache
- Fatigue
- Acne
- Nausea
- Urinary tract infections (UTIs)
- High cholesterol
Ozanimod (Zeposia), an S1P, is another oral medication. Side effects include:
- Upper respiratory tract infections
- Elevated liver enzymes, detected through blood tests
- Headache
- Low blood pressure when you go from sitting or lying to standing
- Changes in breathing
Etrasimod (Velsipity) is another oral S1P receptor modulator. Side effects may include:
- Headache
- Dizziness
- Nausea, vomiting, abdominal (belly) pain tiredness, loss of appetite
- Yellowing of the skin or eyes, dark-colored urine
- Vision problems
- Changes in skin or moles
- Sudden severe headache or confusion
- Seizure
- Problems with your urine
- Cough
- A hard time breathing
What Is the Right Ulcerative Colitis Medication for You?
Your needs will depend on your symptoms, and each person is different. Your ulcerative colitis could start out as mild, then stop for a while, only to come back worse than it was before. Or you may have only mild ulcerative colitis your entire life.
Plus, your body may not respond the same way to a drug as someone else's. And over time, you may find that you need a different type of medicine. For example, something that’s worked well for years may not work anymore. You may need a whole new treatment plan.
Let your doctor know how you’re really doing, and always tell them about any side effects that you have.
Takeaways
Medications for ulcerative colitis can help you manage symptoms and inflammation. You might take aminosalicylates for mild to moderate UC, or corticosteroids for more serious symptoms. If those don't work for you, your doctor might prescribe immunomodulators or biologics. You may have to try a few different drugs, or a combination of drugs, before you start to feel better. Your doctor will work with you to find a treatment that's right for you.
Ulcerative Colitis Medication FAQs
What is the best medicine for ulcerative colitis?
There's no one best medicine to treat ulcerative colitis. If your disease is mild to moderate, your doctor will likely start treatment with a drug in the aminosalicylate group. If it’s more serious, you might take corticosteroids, immunomodulators, or biologics. You might need to need to try different UC medications or take a combination of them before you find a treatment that works for you.
What is the drug of choice for ulcerative colitis?
It depends on how serious your symptoms are. The first drug of choice for mild to moderate ulcerative colitis is usually from the aminosalicylate group. These include balsalazide (Colazal), mesalamine (Apriso, Asacol HD, Canasa, Delzicol, Lialda, Pentasa, Rowasa), olsalazine (Dipentum), and sulfasalazine (Azulfidine).
Is there a pill for ulcerative colitis?
Most medications for mild to moderate UC, and some for moderate to severe UC, come in pill form. But if the problem is in the lower part of your colon, you might use enemas or suppositories to deliver the medicine right to the affected areas. You take others by shot or IV.
How do you calm a colitis flare-up?
Some of the same drugs used to manage UC are also used to calm flare-ups. You might take 5-ASAs or corticosteroids.