Ulcerative Colitis Medications
Medications that are used in the treatment of ulcerative colitis may be divided into two groups, anti-inflammatory and immune suppressive agents. The decision as to which medication regimen should be used will depend upon the severity of the ulcerative colitis. Physicians and patients need to discuss the benefits and risks of recommended treatments.
If the patient has mild or moderate colitis, the first line of treatment is the use of 5-ASA agents-a combination of two drugs sulfonamide (sulfapyridine) and salicylate that helps to control the inflammation. Sulfasalazine (Azulfidine) is the most commonly used of these drugs. Sulfasalazine can be used for as long as needed and can be given along with other drugs. If the patient does not do well on sulfasalazine, they may respond to the newer 5-ASA agents. The side effects of 5-ASA preparations include nausea, vomiting, heartburn, diarrhea, and headache.
Drug therapy for active inflammatory bowel disease includes the following:
- Mesalamine-derivatives (Asacol, Pentasa, Lialda, Delzicol): These are used for Crohn's colitis and ulcerative colitis.
- Antibiotics: Clotrimazole (Lotrimin) and ciprofloxacin (Cipro, Ciloxan) are prescribed for Crohn's disease of the rectum and anus.
- Predigested (elemental or polymeric) diet for small bowel Crohn's disease
If the patient has severe colitis or does not respond to mesalamine preparations, they may be treated with corticosteroids. Prednisone (Deltasone, Orasone, Prednicen-M, Liquid Prep), methylprednisolone (Medrol, Depo-Medrol), budesonide (Entocort EC), budesonide MMX (Uceris) and are used to reduce inflammation. These drugs are taken during a flare-up, but are not used for maintenance when the ulcerative colitis is in remission. Corticosteroids can be taken by mouth, IV infusion, through an enema, or as a suppository, depending upon the location and severity of the inflammation.
Long term use of corticosteroids (may cause side effects including weight gain, acne, facial hair, high blood pressure, mood swings, and increased risk of infection.
A doctor will monitor the patient closely while taking these drugs. The idea is to take corticosteroids only for flare-ups for a short period of time. They do not stop the condition from coming back.
If the patient responds only partially to these treatments or has early relapse, the doctor may consider aggressive therapy. Aggressive therapy may include the following steps:
- Hospital admission
- IV steroids instead of oral steroids
- Increasing the steroid dose
- Use of antibiotics (imidazole or ciprofloxacin or both) for Crohn's disease of the rectum and anus
Suppressing the immune system may help to control the symptoms of ulcerative colitis in patients who have failed first line drug treatment or whose disease is advanced. Medications used for this purpose include:
These medications have significant side effects and need close monitoring. The decision to use them as part of the treatment regimen often requires long discussion between patient and doctor.
If these aggressive measures do not work, surgery may be an option to remove the colon.