Ulcerative colitis is an inflammatory bowel disease (IBD). People with ulcerative colitis have an overactive immune system that attacks and inflames the large intestine, including the colon and rectum. Inflammation leads to symptoms, such as belly cramps, diarrhea, and fatigue.
There’s no cure for ulcerative colitis, but treatment can help manage symptoms and prevent flare-ups.
Some of the medications doctors recommend to treat ulcerative colitis work by calming the immune system to reduce inflammation. Other treatments relieve specific symptoms, such as diarrhea or bloating.
Common medications used to treat ulcerative colitis symptoms include:
- antidiarrheal drugs: loperamide (Imodium)
- pain relievers: acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve)
- aminosalicylates: sulfasalazine, balsalazide, mesalamine, olsalazine
- corticosteroids: prednisone, prednisolone, methylprednisolone, budesonide
- immunomodulators: azathioprine, cyclosporine, tacrolimus, 6-mercaptopurine (6-MP), methotrexate
- biologic drugs: adalimumab (Humira), infliximab (Remicade)
- janus kinase (JAK) inhibitors: tofacitinib (Xeljanz)
- antibiotics: ciprofloxacin (Cipro), metronidazole (Flagyl), rifaximin (Xifaxan)
These medications can cause mild to severe side effects. Your doctor will help you find a treatment that minimizes ulcerative colitis symptoms with side effects you can tolerate.
It’s essential to discuss your symptoms with your doctor. Your treatment needs may change over time.
Here’s a guide to some of the most common side effects of ulcerative colitis medications and how to manage them.
Which drugs can cause it: corticosteroids, immunomodulators
How to manage it: Acne should clear up once you stop taking the medication. Your doctor may prescribe an acne cream or antibiotics to control skin problems in the meantime.
Which drugs can cause it: antibiotics, corticosteroids
How to manage it: If these symptoms bother you, talk with your doctor. They may need to adjust your dose.
Which drugs can cause it: aminosalicylates, antibiotics, immunomodulators, corticosteroids
How to manage it: Abdominal pain and nausea linked to ulcerative colitis symptoms and medications can make you lose your appetite. That can make it hard to get enough nutrients.
Work with your doctor or a dietitian to ensure you’re getting enough calories. Try to eat a variety of nutrient-dense and nutritious foods.
Which drugs can cause it: aminosalicylates, antibiotics, biologics, immunomodulators
How to manage it: Ask your doctor whether you should take your medication on a full stomach or with food to prevent stomach irritation.
Which drugs can cause it: aminosalicylates, immunomodulators
How to manage it: The following tips can help ease constipation.
- Drink extra water so stools are softer and easier to pass.
- Exercise regularly to keep stools moving through your colon.
- Talk with your doctor or a nutritionist about foods you can eat that will help keep you regular without causing ulcerative colitis symptoms.
- Ask your doctor if you should take a laxative or stool softener.
Which drugs can cause it: aminosalicylates, antibiotics, immunomodulators
How to manage it: Ask your doctor about trying an over-the-counter (OTC) antidiarrheal medication or an antispasmodic drug to reduce movement and pain in the bowel. Drink extra fluids to replace what you lose from diarrhea.
Consider keeping a food diary to figure out which foods cause the most symptoms. Avoid foods that make symptoms worse. These often include:
- spicy or fatty foods
- high fiber foods, such as whole grains and some vegetables and fruits
- dairy
- caffeine
Which drugs can cause it: aminosalicylates, corticosteroids, immunomodulators, biologics
How to manage it: Try the following tips when you’re feeling dizzy.
- Sit or lie down in a dark and quiet room until the dizziness goes away.
- Keep your head raised with two or more pillows when you sleep.
- Avoid activities that could be dangerous, such as driving or operating heavy machinery.
If the dizziness persists, ask your doctor if you should change medications.
Which drugs can cause it: aminosalicylates
How to manage it: Use a prescription or OTC mouth rinse or artificial saliva product to add moisture to your mouth.
If dry mouth continues, ask your doctor whether you can adjust your medication dose or switch to a medication that doesn’t cause this side effect.
Which drugs can cause it: aminosalicylates, immunomodulators
How to manage it: Limit or avoid foods that worsen gas. These may include:
- high fiber vegetables (broccoli, Brussels sprouts, cabbage)
- high fiber whole grains, such as bran
- dairy products
- fatty or fried foods
- refined and sugary foods
- artificial sweeteners
Talk with your doctor about taking an OTC gas remedy that contains simethicone.
Which drugs can cause them: aminosalicylates, antibiotics, biologics, corticosteroids, immunomodulators, JAK inhibitors
How to manage it:
An OTC pain reliever, such as acetaminophen, can relieve the occasional headache. If you get headaches often, ask your doctor if you need to reduce the dose of your ulcerative colitis medication or switch to another medication.
Let your doctor know if you have a sudden severe headache. It may be linked to a more serious condition.
Which drugs can cause it: aminosalicylates, antibiotics, immunomodulators
How to manage: Several tips can help you manage heartburn, such as:
- Avoid foods, such as citrus, alcohol, and chocolate, that can irritate your esophagus and make heartburn worse.
- Avoid smoking.
- Avoid eating close to bedtime.
- Don’t lie down right after you eat.
Always talk with your doctor before taking OTC heartburn medications, including proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs).
This can include hives, redness or discoloration, itching, rash, and swelling of the lips and throat.
Which drugs can cause them: biologics
How to manage: Rashes, itchy skin, flushing, and swelling that occur during or within 24 hours of an IV infusion are known as infusion reactions. Other symptoms may include:
- chest discomfort
- high blood pressure
- muscle pain
- nausea
- headache
- dizziness
Infusion reactions are usually mild to moderate in severity and manageable with medications. The healthcare professional who gives you the infusion should monitor you for symptoms and treat you if a reaction occurs.
This may involve redness or discoloration, swelling, itching, and pain.
Which drugs can cause them: biologics
How to manage them: Symptoms usually clear up on their own. Call your healthcare professional if they don’t improve.
Which drugs can cause it: aminosalicylates, biologics, immunomodulators
How to manage it: A heating pad or OTC pain reliever may help with joint or muscle pain in the short term. If it continues, ask your doctor whether you should adjust or change your medications.
Which drugs can cause them: aminosalicylates, antibiotics, biologics, corticosteroids, immunomodulators
How to manage them: The following tips can help reduce nausea and vomiting.
- Take your medication with food.
- Eat several small meals throughout the day rather than three large meals.
- Eat slowly and try to avoid activity after you eat.
- Choose bland foods, such as crackers and toast.
- Avoid greasy, fried, or sweet foods.
- Drink water or ginger ale to stay hydrated.
Which drugs can cause them: aminosalicylates, immunomodulators, biologics, corticosteroids, JAK inhibitors, antibiotics
How to manage: Many of these medications can reduce your protective immune response. Antibiotics also throw off the balance of good and bad bacteria in your body. These factors can put you at an increased risk for respiratory, urinary tract, and intestinal infections.
Make sure you’re up to date on all your vaccinations, including those for the flu, pneumonia, and shingles. Report any signs of infection to your doctor, such as:
- fever
- cough
- pain when you urinate
- bloody stools, diarrhea, abdominal pain, and cramping, which can be signs of a Clostridium difficile (C. diff) infection
Which drugs can cause them: antibiotics, corticosteroids, immunomodulators
How to manage: Medications used to treat ulcerative colitis may cause sleep problems. IBD has also been linked to sleep disturbances.
Ulcerative colitis symptoms can make it harder to sleep. Poor sleep may also raise inflammation in the body linked to conditions, such as ulcerative colitis.
The following tips can improve sleep.
- Consider some physical activity every day.
- Go to bed around the same time every night.
- Avoid heavy meals and screen time before bed.
- Ask your doctor if you can take your medication earlier in the day so it doesn’t interfere with your sleep.
Which drugs can cause it: corticosteroids
How to manage them: Both corticosteroids and ulcerative colitis have been linked to bone loss. Try the following tips to support strong bones.
- Eat a healthy diet rich in vitamin D and calcium.
- Do weight-bearing exercises, such as walking and resistance training.
- Avoid smoking and limit alcohol use, which can weaken your bones.
- Ask your doctor if you should take calcium and vitamin D supplements to strengthen your bones.
Your doctor may also recommend a bone density test. If you have low bone density, you may need to take bone-strengthening medication, such as alendronate (Fosamax) or denosumab (Prolia).
Which drugs can cause it: corticosteroids
How to manage: Weight gain is a common side effect of corticosteroids. It often occurs in the face, back of the neck, and abdomen.
You should begin to lose weight once you stop taking steroid drugs. While you’re still on this medication, watch your calories and engage in physical activity regularly to prevent excess weight gain.
Ask questions each time your doctor prescribes a new treatment for ulcerative colitis. Find out how the medication will help you and what side effects it might cause. Also, you can find out which side effects warrant a call or visit to your doctor’s office.
Many of the side effects listed in this article will go away once your body gets used to the drug. Let your doctor know if any of these problems persist or bother you. They may change your dose or switch you to another medication that doesn’t cause the same side effects.