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Treatment of ulcerative colitis

Start Here More Information Ulcerative colitis care at Mayo Clinic Barium enema Colonoscopy Show more related information Treatment Ulcerative colitis treatment usually involves either medication therapy or surgery. Several categories of medications may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The medications that work well for some people may not work for others. It may take time to find a medication that helps you. In addition, because some medications have serious side effects, you'll need to weigh the benefits and risks of any treatment. Anti-inflammatory medications Anti-inflammatory medications are often the first step in the treatment of ulcerative colitis and are appropriate for most people with this condition. These include: 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Delzicol, Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum). Which medication you take and how you take it — by mouth or as an enema or suppository — depends on the area of your colon that's affected. Corticosteroids. These medications, which include prednisone and budesonide, are generally reserved for moderate to severe ulcerative colitis that doesn't respond to other treatments. Corticosteroids suppress the immune system. Due to the side effects, they are not usually given long term. Immune system suppressors These medications also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these medications works better than one medication alone. Immunosuppressant medications include: Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are commonly used immunosuppressants for the treatment of inflammatory bowel disease. They are often used in combination with medications known as biologics. Taking them requires that you follow up closely with your provider and have your blood checked regularly to look for side effects, including effects on the liver and pancreas. Cyclosporine (Gengraf, Neoral, Sandimmune). This medication is typically reserved for people who haven't responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use. "Small molecule" medications. More recently, orally delivered agents, also known as "small molecules," have become available for IBD treatment. These include tofacitinib (Xeljanz), upadacitinib (Rinvoq) and ozanimod (Zeposia). These medications may be effective when other therapies don't work. Main side effects include the increased risk of shingles infection and blood clots. The U.S. Food and Drug Administration (FDA) recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk of serious heart-related problems and cancer from taking this medication. If you're taking tofacitinib for ulcerative colitis, don't stop taking it without first talking with your health care provider.