Ulcerative Colitis Treatment
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that mainly affects the large intestine, especially the colon. It might be caused by an overactive immune response.
Right now, there’s no known cure for UC, but certain medications—like 5-ASA drugs, corticosteroids, JAK inhibitors, or biologics—can help control symptoms during flare-ups and over the long term.
UC Symptoms
Symptoms can include:
- Stomach pain, discomfort, or cramps
- Ongoing diarrhea
- Blood in stool
These symptoms might stick around or get worse during flare-ups.
How Medications Help
Different drugs can:
- Reduce swelling and irritation from inflammation
- Lower the number of flare-ups
- Help your colon heal
There are five main types of medications used for UC. Here’s a closer look at each, including benefits and possible side effects.
Aminosalicylates (5-ASA Drugs)
These help ease UC symptoms by reducing colon inflammation. They’re best for mild to moderate UC and can prevent or reduce flare-ups.
Examples:
Mesalamine
Taken as:
- Delayed-release tablet
- Extended-release capsule
- Delayed-release capsule
- Rectal suppository or enema
Some forms are available as generics. Brand names include:
- Apriso
- Asacol HD
- Canasa
- Delzicol
- Lialda
- Pentasa
- Rowasa
- sfRowasa (sulfite-free Rowasa)
Side Effects & Interactions
Common side effects:
- Diarrhea
- Headache
- Nausea
- Stomach pain, cramps, discomfort
- Burping
- Rash
Serious (but rare) side effects:
- Chest pain
- Shortness of breath
- Irregular heartbeat
- Liver damage
Drugs it may interact with:
- Azathioprine (Azasan, Imuran)
- Mercaptopurine (Purixan)
- NSAIDs (aspirin, ibuprofen)
Olsalazine
Comes as an oral capsule (brand name Dipentum). No generic version exists.
Side Effects & Interactions
Common side effects:
- Diarrhea/loose stools
- Stomach pain
- Rash/itching
Serious side effects:
- Blood disorders (like anemia)
- Liver failure
- Heart problems
Drugs it may interact with:
- Heparin (blood thinner)
- Low-molecular-weight heparins (Lovenox, Fragmin)
- Thioguanine (chemo drug)
- Mercaptopurine
- Varicella zoster vaccine
Balsalazide
Comes as an oral capsule (generic and brand name Colazal).
Side Effects & Interactions
Common side effects:
- Headache
- Stomach pain
- Diarrhea
- Nausea
- Vomiting
- Respiratory infection
- Joint pain
Serious side effects:
- Blood disorders
- Liver failure
Avoid if allergic to aspirin or salicylates. May interact with NSAIDs or azathioprine.
Sulfasalazine
Taken as an immediate- or delayed-release tablet (generic and brand name Azulfidine).
Side Effects & Interactions
Common side effects:
- Loss of appetite
- Headache
- Nausea
- Vomiting
- Upset stomach
- Lower sperm count
Serious (rare) side effects:
- Blood disorders
- Severe allergic reactions (like Stevens-Johnson syndrome)
- Liver/kidney problems
May interact with folic acid or digoxin (heart medication).
Important Notes on 5-ASA Drugs
The American Gastroenterological Association (AGA) recommends standard-dose oral mesalamine (2–3 grams/day) or diazo-bonded 5-ASA drugs (like olsalazine, balsalazide) over low-dose mesalamine, sulfasalazine, or no treatment.
Sulfasalazine is okay if you’re already in remission on it or can’t afford other options, but it has more side effects.
If standard-dose mesalamine or diazo-bonded drugs don’t work, AGA suggests combining rectal mesalamine with high-dose oral mesalamine (>3 g/day).