Acute, severe ulcerative colitis (called toxic or fulminant colitis) requires hospitalization and intensive, intravenous fluid-replacement or corticosteroid therapy.
One of the first medications prescribed for mild to moderate ulcerative colitis is the drug mesalamine (Liaida, Apriso, Canasa, Pentasa, Asacol).
It belongs to a class of anti-inflammatories called aminosalicylates.
Mesalamine is used both to treat active symptoms of ulcerative colitis and as a maintenance drug to prevent symptom recurrence.
Mesalamine may be taken orally as a tablet or capsule or rectally as a suppository or in an enema. Depending on the formulation, it may be necessary to take three or four doses of mesalamine daily.
For ulcerative proctitis — that is, when the disease confined to your rectum — your doctor may prescribe the suppository formulation alone.
For disease that extends beyond the rectum, your doctor may prescribe a suppository, an enema, and an oral formulation.
Another first-line treatment for ulcerative colitis is the corticosteroid drug budesonide (Entocort, Uceris).
Budesonide can be taken orally as a tablet or capsule or rectally as in a foam or enema.
If you take systemic corticosteroids orally or by injection, you may have significant side effects.
However, because of the way the body processes budesonide, the oral form causes fewer side effects than other corticosteroids.
Nonetheless, local steroids, which are applied just to the place needing treatment, are the preferred option, when possible.
In 2014, the Federal Drug Administration (FDA) approved a rectal budesonide foam for inducing remission of active, mild-to-moderate ulcerative proctitis or proctosigmoiditis (disease extending from the rectum to the lower segment of the colon).
Another form of budesonide, called budesonide multi-matrix system (MMX), is in development.
Budesonide MMX tablets deliver budesonide to the colon, theoretically minimizing the systemic side effects of other corticosteroids.
For severe ulcerative colitis flare-ups, hospitalization and high-dose intravenous corticosteroids are often required.
Once remission is achieved, the dose of steroids is tapered gradually and ultimately stopped.
Steroids are ineffective as maintenance therapy to keep ulcerative colitis in remission.
Possible side effects of steroid use include:
- Weight gain
- High blood sugar
- Increased hair growth on the body and face
- High blood pressure
Immune System Suppressors
Cyclosporine is an immunosuppressant, meaning it works by suppressing the activity of your immune system.
Infliximab is a tumor necrosis factor-alpha (TNF-alpha) inhibitor. It works by blocking the action of TNF-alpha, a substance in the body that causes inflammation.
The immunosuppressant drug azathioprine (Imuran) may also be used to treat ulcerative colitis, alone or in combination with infliximab.
Like corticosteroids, immunosuppressant drugs such as cyclosporine and TNF-alpha inhibitors, raise the risk of infection.
These drugs are also associated with a higher risk of certain cancers.
However, if one of these drugs is controlling your ulcerative colitis symptoms without bothersome side effects, the benefits of continuing the drug may outweigh these risks.
Other medications doctors prescribe to treat ulcerative colitis include:
Last Updated: 5/5/2015