Colitis Medication Options
Medication is a common form of treatment for ulcerative colitis and IBD. Depending on your overall health, the severity of your disease, and other factors, your doctor may recommend different medications to treat your ulcerative colitis symptoms.
Five major classes of medication are used today to treat ulcerative colitis:
These include medications that contain 5-aminosalicylate acid (5-ASA). Examples are sulfasalazine, mesalamine, olsalazine, and balsalazide. These drugs are not specially approved by the Food and Drug Administration (FDA) for use in ulcerative colitis.. However, they can work at the level of the lining of the GI tract to decrease inflammation. They are thought to be effective in treating mild-to-moderate episodes of ulcerative colitis and useful as a maintenance treatment in preventing relapses of the disease. They work best in the colon and are not particularly effective if the disease is limited to the small intestine.
Prednisone, methylprednisolone and budesonide are steroids that are available orally and rectally. Prednisone and methylprednisolone nonspecifically suppress the immune system and are used to treat moderate to severely active ulcerative colitis. (By "nonspecifically," we mean that these drugs do not target specific parts of the immune system that play a role in inflammation, but rather, that they suppress the entire immune response.) These drugs have significant short- and long-term side effects and should not be used as a maintenance medication. Budesonide is a steroid that is used to treat localized inflammation. It has the benefit of minimal systemic exposure with far fewer risks and side effects. Because corticosteroids cause the adrenal glands to slow or stop the natural production of the human steroid cortisol, they cannot be stopped abruptly. If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to add some other medications to help manage your disease.
This class of medications modulates or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators generally are used in people for whom aminosalicylates and corticosteroids haven’t been effective or have been only partially effective. They may be useful in reducing or eliminating the need for corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take several months to begin working.
Antibiotics may be used when infections—such as abscesses—occur. They can also be helpful with fistulas around the anal canal and vagina. Antibiotics used to treat bacterial infection in the GI tract include metronidazole, ampicillin, ciprofloxacin, others.
These therapies represent the latest treatment class used for people suffering from moderate-to-severe ulcerative colitis. These treatments are called biologics because, unlike chemical medications, they are made out of material found in life, usually proteins. Many biologic treatments are proteins called antibodies, which normally are part of the body's immune defense. The antibodies used for biologic therapy have been developed to bind and interfere with the inflammatory process in the disease.