Medicines for ulcerative colitis

Medicines can be used to control the inflammation in your colon and to reduce your body’s immune response.

If you have ulcerative colitis, medications can be used to control the inflammation in your colon and to reduce your body’s immune response. Often medicines are prescribed in a ‘stepped’ (gradually increasing) approach, depending on your response. The main groups of medicines to treat inflammation for ulcerative colitis are:

Aminosalicylates

  • Aminosalicylate medicines are often the first treatment option for mild-to-moderate symptoms.
  • Aminosalicylates help to reduce the inflammation in the colon and control diarrhoea (runny poo).
  • They may be given by mouth (as tablets or capsules), or by enema or suppository through the rectum (bottom), for flare-ups just in the lower large intestine. 
  • Examples include:

Steroids

  • Steroids are used to treat flare-ups when aminosalicylates alone are not effective, or for severe symptoms.
  • They are usually used for a short time only. Steroids aren't recommended for repeated or long-term use. Other effective therapies can reduce the need for steroid medications. 
  • Steroids may be given as tablets, enemas or suppositories.
  • Examples of tablets and capsules are budesonide (Entocort®), prednisone and methylprednisolone.
  • Steroids also come as an enema: hydrocortisone acetate enema (Colifoam®). Enemas are used when inflammation is confined to the left side of the colon and work mainly in the bowel, to reduce side-effects in the rest of the body. The enema delivers the medication directly to the place it's most needed. 
  • For more severe cases, hydrocortisone or methylprednisolone may be given in hospital intravenously (as a drip in the vein).

Azathioprine

  • Azathioprine is usually prescribed when symptoms don't respond to aminosalicylates.
  • It suppresses the immune system and in this way reduces the inflammation in the bowel.
  • Azathioprine takes time to work. It can take up to 2 to 3 months before you feel better.
  • You will need regular blood tests to monitor your blood cells, liver and kidney function while you are taking it. Read more about azathioprine. 

Biologics (TNF inhibitors)

  • Examples include infliximab (Remicade) and adalimumab (Humira, Amgevita).
  • They are given by injection.
  • Biologics are used for people with severe ulcerative colitis when other medications are not working, or for people who have a fistula.
  • These medications target a protein made by the immune system and in this way, reduce inflammation in the gut. They work quickly to bring on remission.
  • These are started by a specialist, and you must meet certain criteria to have these.

References

  1. Inflammatory bowel disease – a focus on Crohn’s disease and ulcerative colitis BPAC, NZ, 2021
  2. Chronic bowel disorders New Zealand New Zealand Formulary
Credits: Sandra Ponen, pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 03 Oct 2022