Side Effects And Interactions
The more common side effects of biologics can include:
Biologic drugs may interact with other drugs and biologic agents, including:
- natalizumab , which can be used to treat Crohns disease or multiple sclerosis
- tocilizumab , anakinra , abatacept , which are primarily used to treat arthritis
- theophylline , an asthma medication
- live vaccines such as the varicella zoster vaccine
Complementary And Alternative Therapies
Although diet cannot cure ulcerative colitis, some studies suggest that people who eat foods high in saturated fat and sugar, and who eat less amounts of fruits and vegetables, may be at greater risk of developing the disease. Certain foods may also reduce symptoms.
- Limit intake of dairy products, which may help reduce diarrhea.
- Eat fruits and vegetables and pay attention to fiber. Although fiber is crucial to a healthy diet, some people with inflammatory bowel disease find that fiber makes symptoms worse. If fiber bothers you, steam or bake your vegetables instead of eating them raw, and avoid high-fiber foods such as broccoli, cauliflower, and raw apples. Eat antioxidant foods, including fruits and vegetables .
- A bland, low-fiber diet may be best during acute flares.
- Eat 5 to 6 small meals a day.
- Certain foods may aggravate symptoms of ulcerative colitis .
- Avoid refined foods, such as white breads and pastas.
- Avoid caffeine, alcohol, and tobacco.
People with significant malnourishment, severe symptoms, or those awaiting surgery may require parenteral nutrition.
Nutrition and Supplements
What To Expect At Your Doctor’s Office
Your doctor will do a physical exam and a series of tests to diagnose ulcerative colitis. Blood tests may show anemia and a high white blood cell count . Stool samples may show whether there is bleeding or infection in the colon or rectum.
The following procedures may also help distinguish between ulcerative colitis, Crohn disease, and other inflammatory conditions.
Colonoscopy and sigmoidoscopy: In a colonoscopy, a doctor uses a long, flexible, lighted tube with a camera to take pictures of the colon. These pictures can reveal inflammation, bleeding, or ulcers along the entire colon wall. Your doctor may also take a biopsy of colon cells to see whether you have ulcerative colitis or Crohn disease. The person is sedated during the procedure. A sigmoidoscopy is similar, but is used to examine the rectum and lower part of your colon. It can be done without sedation, but may miss inflammation higher in the colon or the small intestine.
Barium enema: This test examines the large intestine with an x-ray. You receive barium as an enema, which coats the lining of your large intestine and rectum. It is generally not as reliable as colonoscopy and is not used when symptoms are severe because of the risk of complications.
Small intestine x-ray: In this test, you drink a barium “shake” and the doctor takes an x-ray of your small intestine. This test allows doctors to see the small intestine . It can help distinguish between ulcerative colitis and Crohn disease.
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So What Is The Best Medication For Ulcerative Colitis
As far as ideal treatments go, it really is patient dependent. The ideal solution for one ulcerative colitis patient may be intolerable for another. That said, based on the data collected by Vivisum for its Ulcerative Colitis Market Landscape research library, one drug emerged as consistently performing well among the six aforementioned clinical attributes: Entyvio
When asked to rate the top two most ideal ulcerative colitis drugs, 63% of surveyed gastroenterologists included Entyvio. Entyvios highly rated safety profile and its efficacy provide gastroenterologists with one of the best medications for ulcerative colitis. And less than one-third of surveyed HCPs rated Entyvios access as a weakness. For these reasons, its no surprise that Entyvio has grabbed the highest patient share among the eight profiled branded drugs in Vivisums analysis.
How Do They Work
These are chemically similar to the over-the-counter pain reducer, aspirin. They decrease the inflammatory response, so damaged tissues can heal. These medications block your body from making prostaglandins, or on-off switches in your cells that regulate pain and inflammation. Recent research also suggests that they decrease damaging molecules in your body.
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Side Effects Of Ulcerative Colitis
Side effects are based on the biologic medication that youre receiving. While some are minor, others may be life-threatening. You should talk to your doctor before receiving infusion therapy to ensure that you are getting the best option for your UC. The most common side effects include:
- Serious allergic reactions
- Lymphoma and other cancers including skin and cervical cancer
- Heart problems including failure
Uc Treatment Options At A Glance
The most commonly used treatments for UC:
These drugs, given orally or rectally, are anti-inflammatory compounds that contain 5-aminosalicylic acid . They decrease inflammation at the wall of the intestine. Examples of 5-ASAs include sulfasalazine, balsalazide, mesalamine, and olsalazine.
Metronidazole, ciprofloxacin, and other antibiotics may be used when infections occur, or to treat complications of ulcerative colitis.
Biologics for UC are designed to suppress the immune system to reduce inflammation. Certain biologics work by targeting specific inflammatory proteins called cytokines that play a role in inflammation. Others work by preventing certain white blood cells from getting into inflamed tissues.
Prednisone, prednisolone, and budesonide are included in this type of medication. They affect the bodys ability to initiate and maintain an inflammatory processkeeping the immune system in check. While effective for short-term flare-ups, theyre not recommended for long-term use.
These modify the bodys immune system activity to stop it from causing ongoing inflammation These drugs are usually used for people who have responded only to steroids.
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Extraintestinal Manifestations And Complications
UC is characterized by immune dysregulation and systemic inflammation, which may result in symptoms and complications outside the colon. Commonly affected organs include: eyes, joints, skin, and liver. The frequency of such extraintestinal manifestations has been reported as between 6 and 47%.
UC may affect the mouth. About 8% of individuals with UC develop oral manifestations. The two most common oral manifestations are aphthous stomatitis and angular cheilitis. Aphthous stomatitis is characterized by ulcers in the mouth, which are benign, noncontagious and often recurrent. Angular chelitis is characterized by redness at the corners of the mouth, which may include painful sores or breaks in the skin. Very rarely, benign pustules may occur in the mouth .
UC may affect the eyes. Inflammation may occur in the interior portion of the eye, leading to uveitis and iritis. Uveitis can cause blurred vision and eye pain, especially when exposed to light . Untreated, uveitis can lead to permanent vision loss. Inflammation may also involve the white part of the eye or the overlying connective tissue , causing conditions called scleritis and episcleritis. Uveitis and iritis are more commonly associated with ulcerative colitis, whereas episcleritis is more commonly associated with Crohn’s disease.
Some Ingredients In Supplements
According to the Crohns and Colitis Foundation, people should avoid supplements that contain:
All of these may aggravate a persons UC symptoms, particularly during a flare-up.
The Crohns and Colitis Foundation also adds that people should avoid taking any supplements on an empty stomach.
A person should check with a medical professional before taking any supplements, including herbal supplements, over-the-counter medications, and complementary therapies.
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How Is Ulcerative Colitis Treated
Theres no cure for ulcerative colitis, but treatments can calm the inflammation, help you feel better and get you back to your daily activities. Treatment also depends on the severity and the individual, so treatment depends on each persons needs. Usually, healthcare providers manage the disease with medications. If your tests reveal infections that are causing problems, your healthcare provider will treat those underlying conditions and see if that helps.
The goal of medication is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis. Healthcare providers use several types of medications to calm inflammation in your large intestine. Reducing the swelling and irritation lets the tissue heal. It can also relieve your symptoms so you have less pain and less diarrhea. For children, teenagers and adults, your provider may recommend:
Children and young teenagers are prescribed the same medications. In addition to medications, some doctors also recommend that children take vitamins to get the nutrients they need for health and growth that they may not have gotten through food due to the effects of the disease on the bowel. Ask your healthcare provider for specific advice about the need for vitamin supplementation for your child.
You might need surgery that removes your colon and rectum to:
- Avoid medication side effects.
- Prevent or treat colon cancer .
- Eliminate life-threatening complications such as bleeding.
What To Expect From Your Doctor
Your provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your provider may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Do you have abdominal pain?
- Have you had diarrhea? How often?
- Have you recently lost any weight unintentionally?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Have you ever experienced liver problems, hepatitis or jaundice?
- Have you had any problems with your joints, eyes, skin rashes or sores, or had sores in your mouth?
- Do you awaken from sleep during the night because of diarrhea?
- Have you recently traveled? If so, where?
- Is anyone else in your home sick with diarrhea?
- Have you taken antibiotics recently?
- Do you regularly take nonsteroidal anti-inflammatory medications, such as ibuprofen or naproxen sodium ?
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Sometimes The Best Medication For Ulcerative Colitis Is The One Patients Can Get
Its hard for doctors to ignore access and insurance when deciding which medication to prescribe an ulcerative colitis patient. Many treatments that have been available for decades are well-covered by insurance companies. But they may not always work as well and may not be the best fit for a patients unique set of needs.
Alternately, emerging biologics offer tremendous benefits, but they come at a high cost and insurance companies often need to see that patients have tried other treatments prior to approving and paying for a biologic.
Access plays a significant role in how gastroenterologists determine the best medication for ulcerative colitis. To continue the Remicade example from earlier, Vivisum found that HCPs perceptions of Remicades access put it among the top two UC drugs for insurance coverage. This makes sense given that Remicade has been available for decades. A gastroenterologist may determine that a patient needs to switch to a biologic but her insurance will not cover Entyvio, for instance. So Remicade becomes a much more viable option and the best choice for this patient. Although it may not have been the HCPs first choice, Remicade will still provide high efficacy for the patient and the patient will not face a heavy financial burden for treatment.
Ulcerative Colitis Treatment: All You Need To Know
Elizabeth Oliver, PhD
Ulcerative colitis is an inflammatory bowel disease. It causes inflammation and ulcers in the inner lining of the large intestine . Ulcerative colitis is a chronic condition. The goal of treatment is to reduce the inflammation that causes symptoms in order to prevent flare-ups and maintain longer periods of remission.
Treatment options for ulcerative colitis usually include either medication or surgery, as well as a focus on diet and nutrition. Because the symptoms of ulcerative colitis vary from person to person there is no single treatment that works for everyone.
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How Do Doctors Treat Ulcerative Colitis
Doctors treat ulcerative colitis with medicines and surgery. Each person experiences ulcerative colitis differently, and doctors recommend treatments based on how severe ulcerative colitis is and how much of the large intestine is affected. Doctors most often treat severe and fulminant ulcerative colitis in a hospital.
If Your Doctor Has Recommended Infusion Therapy Let Infusion Associates Help You
At Infusion Associates, we provide medically-prescribed infusion therapy for patients with chronic conditions in a welcoming and friendly environment. Our team of healthcare professionals is fully committed to making the experience as comfortable as possible for you or your patients. We always inform patients of any potential side effects and answer all their questions before starting treatment. In addition, we have a Registered Pharmacist on-site to make the process as seamless as possible.
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Side Effects Of Corticosteroids
However, people should not use corticosteroids over the long term because they can cause the following side effects:
- developing a round or moon-shaped face
Corticosteroids can also cause short-term side effects, including:
- sleeping issues
- behavioral changes
A person should consult a doctor to determine their dosage of corticosteroids to avoid and prevent possible side effects.
Doctors refer to these drugs as immunosuppressants or immunomodulators. They target IBD inflammation by managing the bodys immune system response.
Medical professionals generally prescribe them:
- when aminosalicylates and corticosteroids have not worked
- to reduce the use of corticosteroids
- to help someone stay in remission longer
It can take up to 3 months to see results from immunomodulators.
The following are common immunomodulators:
There are several different types of this therapy, including:
What Other Information Should I Know
If you are taking mesalamine delayed-release tablets , you may notice the tablet shell or part of the tablet shell in your stool. Tell your doctor if this happens frequently.
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests before and during your treatment.
Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking mesalamine.
Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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How Often Do I Need A Colonoscopy
Especially when you have symptoms or are just starting or changing medications, your doctor may want to periodically look at the inside of the rectum and colon to make sure the treatments are working and the lining is healing. How often this is needed is different for each person.
Ulcerative colitis also increases your chance of developing colon cancer. To look for early cancer signs, your healthcare provider may have you come in for a colonoscopy every one to three years.
When To See A Doctor
See your health care provider if you experience a persistent change in your bowel habits or if you have signs and symptoms such as:
- Ongoing diarrhea that doesn’t respond to nonprescription medications
- Diarrhea that awakens you from sleep
- An unexplained fever lasting more than a day or two
Although ulcerative colitis usually isn’t fatal, it’s a serious disease. In some cases, ulcerative colitis may cause life-threatening complications.
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Prednisone Prednisolone And Methylprednisolone
Prednisone is taken by mouth and is available as:
- an immediate-release tablet
- a delayed-release tablet
- a liquid solution
Its available as a generic drug and as the brand-name drugs Prednisone Intensol and Rayos .
The forms of prednisolone that are FDA approved for UC are:
- immediate-release tablet
- liquid solution
You can take any of these forms by mouth. Prednisolone is available as a generic drug and as the brand-name drugs Millipred and Prelone .
Methylprednisolone comes in two forms:
- injectable medication
Its available as a generic drug and as the brand-name drugs Medrol and Depo-Medrol .
Side effects, complications, and interactions
When given in high doses, the side effects of these drugs are similar. The more common side effects can include:
- increased blood sugar levels
Immunomodulators are drugs that decrease the bodys response to its own immune system. The result is lowered inflammation throughout your body.
Immunomodulators may reduce the number of UC flare-ups you have and help you stay symptom-free longer.
Theyre generally prescribed to people whose symptoms havent been managed with 5-ASA drugs and corticosteroids. However, these drugs may take several months to start working.
The FDA has not approved immunomodulators for the treatment of UC.
However, theyre well supported in medical literature as useful options, and your doctor may still prescribe them. This is known as off-label drug use.
What Other Medications Are Given For Ibd
As well as the medications above you may also be given some medications to help with other symptoms you experience as a result of your IBD.
Antacids work to control acid levels in your stomach for people who suffer from heartburn, acid reflux and indigestion.
PPIs are used to reduce gastric acid production and include omeprazol, esomeprazole, lansoprazole, pantoprazoleand rabeprazole. They are commonly used to treat acid reflux and ulcers of the stomach and part of the small intestine called the duodenum.
Unfortunately for some people with IBD pain is an everyday occurrence and can severely affect your quality of life. There are a range of pain relief options which you may be given, depending on the what and where the pain is. These include:
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