Medicines for ulcerative colitis

Key points about ulcerative colitis medicines

  • 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.
  • Find out how to take them safely and possible side effects.
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The main groups of medicines to treat inflammation for ulcerative colitis are:

  • Aminosalicylates
  • Steroids
  • Azathioprine
  • Biologics (TNF inhibitors).

  • 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 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 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. 

  • 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.


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NPS MedicineWise, Australia, 2021

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland

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