Ulcerative colitis is a type of inflammatory bowel disease (IBD) that mainly affects the colon (large intestine). It may be caused by an abnormal response from your body’s immune system. While there’s no known cure for ulcerative colitis, several types of medication can be used to manage the symptoms.

Symptoms of ulcerative colitis can include:

  • abdominal pain, discomfort, or cramps
  • persistent diarrhea
  • blood in the stool

Symptoms may be constant or they may get worse during flare-ups.

Various medication can be used to decrease inflammation (swelling and irritation), reduce the number of flare-ups you have, and allow your colon to heal. Four main classes of drugs are used to treat people with ulcerative colitis.

Aminosalicylates are thought to reduce symptoms of ulcerative colitis by reducing inflammation in the colon. These drugs are used in people with mild to moderate ulcerative colitis. They can help prevent flare-ups or reduce the number of flare-ups you have.

Examples of these drugs include:

Sulfasalazine

Sulfasalazine is taken by mouth as an immediate-release or delayed-release tablet. Sulfasalazine is available as a generic drug and as the brand-name drug Azulfidine.

The more common side effects of sulfasalazine can include:

  • loss of appetite
  • headache
  • nausea
  • vomiting
  • upset stomach
  • decreased semen levels in men

Other rare but serious side effects of sulfasalazine include:

  • blood disorders such as anemia
  • severe allergic reaction such as Stevens-Johnson syndrome
  • liver failure
  • kidney problems

Sulfasalazine may interact with other drugs, such as:

  • digoxin
  • folic acid

Mesalamine

Mesalamine may be taken orally (by mouth) as a delayed-release tablet, extended-release capsule, or delayed-release capsule. Mesalamine is also available as a rectal suppository or rectal enema.

Mesalamine is available as a generic drug in some forms. It also has several brand-name versions, such as Delzicol, Apriso, Pentasa, Rowasa, sfRowasa, Canasa, Asacol HD, and Lialda.

The more common side effects of mesalamine can include:

  • diarrhea
  • headache
  • nausea
  • abdominal pain, cramps, and discomfort
  • increased stomach acidity or reflux
  • vomiting
  • burping
  • rash

Rare but serious side effects of mesalamine can include:

  • chest pain
  • shortness of breath
  • irregular heart rhythm

Examples of drugs that mesalamine can interact with include:

  • thioguanine
  • warfarin
  • varicella zoster vaccine

Olsalazine

Olsalazine comes as a capsule you take by mouth. It’s available as the brand-name drug Dipentum. It’s not available as a generic drug.

The more common side effects of olsalazine can include:

  • diarrhea or loose stools
  • pain in your abdomen
  • rash or itching

Serious side effects of olsalazine can include:

  • blood disorders such as anemia
  • liver failure
  • heart problems such as heart rhythm changes and inflammation of your heart

Examples of drugs that olsalazine can interact with include:

  • heparin
  • low-molecular weight heparins such as enoxaparin or dalteparin
  • mercaptopurine
  • thioguanine
  • varicella zoster vaccine

Balsalazide

Balsalazide is taken by mouth as a capsule or tablet. The capsule is available as a generic drug and as the brand-name drug Colazal. The tablet is only available as the brand-name drug Giazo.

The more common side effects of balsalazide can include:

  • headache
  • abdominal pain
  • diarrhea
  • nausea
  • vomiting
  • respiratory infection
  • joint pain

Serious side effects of balsalazide can include:

  • blood disorders such as anemia
  • liver failure

Examples of drugs that balsalazide can interact with include:

  • thioguanine
  • warfarin
  • varicella zoster vaccine

Corticosteroids decrease your body’s overall immune system response to decrease inflammation in your body. These types of drugs are used to treat people with moderate to severe active ulcerative colitis. Corticosteroids include:

Budesonide

Two forms of budesonide that are approved for ulcerative colitis are extended-release tablets and rectal foam. Both are available as the brand-name drug Uceris. They’re not available as generic drugs.

The more common side effects of budesonide can include:

  • headache
  • nausea
  • decreased levels of the hormone cortisol
  • pain in your upper abdomen
  • tiredness
  • bloating
  • acne
  • urinary tract infection
  • joint pain
  • constipation

Serious side effects of budesonide can include:

  • vision problems such as glaucoma, cataracts, and blindness
  • high blood pressure

Budesonide can interact with other drugs such as:

  • protease inhibitors such as ritonavir, indinavir, and saquinavir, which are used to treat HIV infections
  • antifungal drugs such as itraconazole and ketoconazole
  • erythromycin
  • oral contraceptives that contain ethinyl estradiol

Prednisone and prednisolone

Prednisone is available in tablet, delayed-release tablet, and liquid solution forms. You take any of these by mouth. Prednisone is available as a generic drug and as the brand-name drugs Deltasone, Prednisone Intensol, and Rayos.

The forms of prednisolone that are approved for ulcerative colitis are:

  • tablets
  • dissolving tablets
  • liquid solution
  • syrup

You can take any of these forms by mouth. Prednisolone is available as a generic drug and as the brand-name drug Millipred.

The more common side effects of prednisone and prednisolone can include:

  • increased blood sugar levels
  • restlessness or anxiety
  • increased blood pressure
  • swelling due to fluid retention in your legs or ankles
  • increased appetite
  • weight gain

Serious side effects of prednisone and prednisolone can include:

  • osteoporosis and increased risk of bone fracture
  • heart problems such as heart attack, chest pain, and heart rhythm changes
  • seizures

Examples of drugs that prednisone and prednisolone can interact with include:

  • antiseizure drugs such as phenobarbital and phenytoin
  • blood thinners such as warfarin
  • rifampin
  • ketoconazole
  • aspirin

Immunomodulators are drugs that decrease a body’s response to its own immune system. The result is decreased inflammation throughout a person’s body. Immunomodulators may reduce the number of ulcerative colitis flare-ups you have and help you stay symptom-free longer.

Immunomodulators are generally used in people whose symptoms have not been controlled with aminosalicylates and corticosteroids. However, these drugs may take several months to start working.

Immunomodulators include:

Tocacitinib

Until recently, immunomodulators were not approved by the U.S. Food and Drug Administration (FDA) to treat people with ulcerative colitis. Nonetheless, this class of drugs was sometimes used off-label to treat people with ulcerative colitis.

One such off-label use became a thing of the past in 2018 when the FDA approved use of an immunomodulator for people with ulcerative colitis. This immunomodulator is called tofacitinib (Xeljanz). It was previously FDA-approved for people with rheumatoid arthritis but was used off-label for people with ulcerative colitis. Xeljanz is the first medication of its kind that is given orally — rather than by injection — for long-term treatment of people with ulcerative colitis.

Learn more about off-label drug use.

Methotrexate

Methotrexate is available as a tablet you take by mouth. It’s also given by intravenous (IV) infusion as well as subcutaneous and intramuscular injections. The tablet is available as a generic drug and as the brand-name drug Trexall. The IV solution and intramuscular injection are only available as generic drugs. The subcutaneous injection is only available as the brand-name drugs Otrexup and Rasuvo.

Azathioprine

For ulcerative colitis treatment, azathioprine comes as a tablet you take by mouth. It’s available as a generic drug and as the brand-name drugs Azasan and Imuran.

Mercaptopurine

Mercaptopurine is available as a tablet or a liquid suspension, both taken by mouth. The tablet is only available as a generic drug, and the suspension is only available as the brand-name drug Purixan.

Side effects of methotrexate, azathioprine, and mercaptopurine

The more common side effects of these immunomodulators can include:

  • headache
  • nausea
  • vomiting
  • diarrhea
  • mouth sores
  • tiredness
  • low blood cell levels

Examples of drugs that immunomodulators can interact with include:

  • allopurinol
  • aminosalicylates such as sulfasalazine, mesalamine, and olsalazine
  • angiotensin-converting enzyme (ACE) inhibitors such as lisinopril and enalapril
  • warfarin
  • ribavirin
  • nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen
  • phenylbutazone
  • phenytoin
  • sulfonamides
  • probenecid
  • retinoids
  • theophylline

Biologics are genetically designed drugs developed in a lab from a living organism. These drugs prevent certain proteins in your body from causing inflammation. Biologic drugs are used for people with moderate to severe ulcerative colitis. They’re also used for people whose symptoms have not been controlled with treatments such as aminosalicylates, immunomodulators, or corticosteroids.

There are five biologic drugs used for ulcerative colitis symptom management. These are only available as brand-name drugs, including:

  • adalimumab (Humira), given by subcutaneous injection
  • golimumab (Simponi), given by subcutaneous injection
  • infliximab (Remicade), given by IV infusion
  • infliximab-dyyb (Inflectra), given by IV infusion
  • vedolizumab (Entyvio), given by IV infusion

You may need to take adalimumab, golimumab, infliximab, or infliximab-dyyb for up to eight weeks before you see any improvement. Vedolizumab typically starts to work in six weeks.

The more common side effects of biologic drugs can include:

  • headache
  • fever
  • chills
  • hives or rash
  • increased infections

Biologic drugs may interact with other biologic agents. Examples of these include:

  • natalizumab
  • adalimumab
  • golimumab
  • infliximab
  • anakinra
  • abatacept
  • tocilizumab
  • warfarin
  • cyclosporine
  • theophylline
  • live vaccines such as the varicella zoster vaccine

NSAIDs, such as ibuprofen and naproxen, typically reduce inflammation in the body. If you have ulcerative colitis, though, these drugs may make your symptoms worse. Be sure to talk with your doctor before taking an NSAID.

Many drugs can help reduce your ulcerative colitis symptoms. If you have ulcerative colitis, review this article with your doctor and talk about which medications may be right for you. Your doctor will suggest medications based on factors such as your overall health and how severe your condition is.

You may need to try a few medications before you find a treatment plan that works for you. If taking one medication doesn’t reduce your symptoms enough, your doctor may add a second medication that makes the first one more effective. It may take some time, but your doctor will work with you to find the right medications to help relieve your ulcerative colitis symptoms.