For Your Patients: Starting Drug Therapy for Ulcerative Colitis

You've just been diagnosed with ulcerative colitis. Now your doctor will most likely suggest that you take certain drugs to relieve the symptoms. Here is what to expect.

First, as the doctor already explained, there is no cure for ulcerative colitis. But the good news is that, in most cases, it can be brought into remission quickly. You may experience setbacks along the way and your therapy may need to change, but most patients are able to achieve control of symptoms (remission) on medications without the need for long-term steroids (prednisone).

The most common drug to be used initially in mild-to-moderate ulcerative colitis is called mesalamine. It's available under numerous brand names, including Asacol, Apriso, Pentasa, and Lialda. Mesalamine is a chemical cousin of aspirin that's formulated to work in only the large intestine, where its anti-inflammatory effect helps heal the lesions responsible for your symptoms. (Aspirin itself does not relieve ulcerative colitis and may actually worsen it.)

Mesalamine is usually taken by mouth, but it is also available as a suppository or enema. Your doctor may suggest the latter if your ulcerative colitis is concentrated on the left side (the part nearest the rectum).

Other oral medications used in newly diagnosed patients include drugs similar to mesalamine but with different side effects. These include sulfasalazine, olsalazine, and balsalazide.

For drugs in this class, called 5-ASAs, the most common side effects are headache, nausea/vomiting, and diarrhea. The printed information with whatever you are prescribed may also list a large number of serious but rare effects. You should tell your doctor immediately about any side effects you are experiencing.

Depending on the specifics of your condition, your doctor may also recommend steroids in addition to a 5-ASA drug.

While some patients feel improvement within days of starting, many patients may need several weeks before they see major relief. You will need to go back to the doctor regularly to make sure the drug is working and not causing any untoward problems. Dosages may change and once remission is achieved, you may switch to a different maintenance drug.

If you were unlucky enough to be diagnosed with more severe disease -- such as having upwards of six bowel movements per day with blood in them all the time -- your treatment will need to be more aggressive. Drugs including the following are recommended for initial treatment in severe ulcerative colitis:

• Injection drugs such as infliximab (Remicade), vedolizumab (Entyvio), or ustekinumab (Stelara)

• Steroids, perhaps orally, for temporary relief

Read previous installments in this series:

What Is Ulcerative Colitis?

I've Had Diarrhea That Won't Go Away -- What Should I Do?

UC -- Why Me?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.