What medicines are prescribed for ulcerative colitis?
The treatment for mild to moderate ulcerative colitis generally begins with anti-inflammatory, antidiarrheal medications, and corticosteroids, along with rehydration through fluid intake. The objective of treatment with drugs for ulcerative colitis is to reduce inflammation in the colon.
They control or prevent inflammation in the intestines and help in various ways such as:
- Relieving the symptoms
- Promoting healing of damaged tissues
- Preventing disease recurrence and keeping it from flaring up again
- Postponing or preventing the need for surgical treatment.
If it is acute ulcerative colitis (also called toxic or fulminant colitis), your doctor may recommend hospitalization. Intravenous fluid-replacement or corticosteroid therapy may be delivered in such cases Fluid intake for rehydration is carried on along with drugs even if the condition is mild or moderate.
Various medications that are used for the treatment of conditions associated with ulcerative colitis are as follows:
The first medication that is prescribed for mild to moderate ulcerative colitis is mesalamine (Liaida, Pentasa, Apriso, Canasa, Asacol). It is an anti-inflammatory drug and belongs to a class called aminosalicylates. Mesalamine is used to treat symptoms of ulcerative colitis and to prevent their recurrence.
Mesalamine may be delivered orally as a tablet or rectally. It may be required to take three or four doses of mesalamine every day.
If the disease symptoms are confined to the rectum, the drug may be delivered as suppository formulation alone. But if the disease extends beyond your rectum, your doctor may prescribe a suppository, an enema, and an oral formulation.
Anti-inflammatory medications that aim to decrease intestinal inflammation are analogous to arthritis medications that decrease inflammation (arthritis) of the joints. Some examples of these drugs are topical 5-ASA compounds such as sulfasalazine (Azulfidine), olsalazine (Dipentum), and mesalamine (Pentasa, Asacol, Lialda, Apriso Rowasa enema).
5-ASA (5-aminosalicylic acid) (also called mesalamine) is chemically similar to aspirin. Aspirin (acetylsalicylic acid) is generally used in treating arthritis and various other diseases involving inflammation of the tissues. Aspirin, however, is not very effective in treating ulcerative colitis. But, mesalamine is effective in treating ulcerative colitis if the drug is delivered directly onto the colon lining that has become inflammed.
Another first-line treatment for ulcerative colitis is the use of corticosteroids such as the drug budesonide (Entocort, Uceris). Budesonide can be delivered orally as a tablet or rectally. These medicines can cause major side effects particularly if these are taken orally or by injection.
Budesonide, however, causes fewer side effects than other corticosteroids when taken orally as a tablet or capsule.
If you suffer with severe ulcerative colitis flare-ups, you may be asked for hospitalization and a high-dose of intravenous corticosteroids is prescribed generally. As the symptoms subside, the dose of steroids is tapered gradually and eventually stopped.
Side effects of these drugs can be:
- Hair growth on the body and face
- High blood pressure
- Weight gain
- High blood sugar
Immune System Suppressants
In acute ulcerative colitis, intravenous corticosteroids aren't generally effective. Therefore, your doctor may prescribe intravenous cyclosporine (Sandimmune) or infliximab (Remicade). Cyclosporine is an immunosuppressant and works by suppressing your immune system.
Infliximab is another such drug that works by blocking the action of TNF-alpha, which is a substance in your body that causes inflammation.
Immunosuppressants may be used to treat ulcerative colitis alone or in combination with infliximab.
Immunosuppressing drugs have some side effects. These medicines can raise the risk of infection. These drugs are also associated with a higher risk of certain types of cancers.
Other medicines for ulcerative colitis
Other medicines that your doctor may prescribe to treat ulcerative colitis can include:
- Antidiarrheal medicines to control diarrhea
- Iron supplements in case you have chronic bleeding in intestines that could cause anemia
- Antibiotics if you have a fever and to control infections
- Pain relieving medicines, such as acetaminophen. But some medicines such as ibuprofen, naproxen, or diclofenac are not recommended, because they can worsen the symptoms of ulcerative colitis.
There is no drug that can cure ulcerative colitis completely. Patients with ulcerative colitis generally experience periods of worsening of inflammation followed by periods of remission when the inflammation is reduced. These periods may last for months to years.
During relapses of the symptoms, condition worsens and you experience severe abdominal pain, diarrhea, and rectal bleeding. During periods of remissions, these symptoms subside gradually. Remissions usually happen because of treatment, but sometimes it may occur spontaneously without any treatment. Read about other methods of treatment of ulcerative colitis.