Since inflammatory bowel diseases (IBDs), including ulcerative colitis, are individual by nature, experts say it’s important to note that treatments that work for one patient may not work for another. “That is why it is so critical that patients with these diseases have many different treatment options available to them,” says Laura Wingate, vice president of education, support, and advocacy at the Crohn’s & Colitis Foundation. “Their healthcare providers will customize treatment to the individual’s needs based on type and severity of the disease.” Ashwin Ananthakrishnan, MBBS, a gastroenterologist who specializes in inflammatory bowel diseases at Massachusetts General Hospital in Boston, says that serious side effects are rare with any of the therapies for ulcerative colitis. But they can occur, and he urges patients to “always report new symptoms to their doctor, particularly if persistent for more than a couple of days, or severe.” Here’s a list of common ulcerative colitis drugs and their side effects.
Azulfidine (Sulfasalazine) Side effects are uncommon but can include headache, nausea, loss of appetite, stomach pain, vomiting, rash, fever, and decreased white blood cell count. While harmless, it can also cause yellowing of the skin (jaundice). Men may experience decreased sperm production and function while taking sulfasalazine, but fertility will return to normal after the drug is stopped.Lialda (Mesalamine) Side effects may include abdominal pain and cramps, diarrhea, gas, nausea, hair loss, headache, and dizziness. Some studies show that taking mesalamine may be associated with kidney problems, so people with kidney disease should use caution before taking the drug.Dipentum (Olsalazine) Diarrhea is the most common side effect of olsalazine, but the risk can be reduced by taking the medication with food. Less common side effects include headache, rash, itching, joint pain, fatigue, and rarely, hair loss.Colazal (Balsalazide) Side effects may include headaches and abdominal pain and, less commonly, trouble sleeping, dry mouth, muscle or back pain, nausea, diarrhea, vomiting, fever, and cold symptoms like stuffy nose, sore throat, and sneezing.
In rare instances, 5-ASA drugs have been linked to inflammation of the pancreas (pancreatitis) and inflammation of the heart or tissue surrounding the heart (myocarditis and pericarditis, respectively). Doctors may prescribe another class of powerful anti-inflammatory drugs called corticosteroids for treatment of acute IBD flare-ups. Still, they’re not recommended for long-term use because of problematic side effects, including fluid retention and swelling of the lower legs, increased risk of infection, high blood pressure, weight gain, acne, thinning skin and easier bruising, mood swings, insomnia, cataracts, glaucoma, high blood sugar levels, and weakened bones or osteoporosis.
Immune System Suppressor Side Effects
Immune system suppressors weaken the activity of the immune system to decrease the inflammatory response. Some of the commonly used drugs, and their side effects, include these options:
Imuran (Azathioprine) Infrequently reported side effects include headache, nausea, vomiting, diarrhea, skin rash, and hair loss. Even less common side effects are pancreatitis and increased risk of infection or bleeding. This drug may increase the risk of lymphoma and skin cancer. Use of azathioprine can also rarely lead to a serious brain infection. You should contact your doctor right away if you develop problems with muscle movement, speech, thought, or vision — these symptoms may come on gradually but quickly worsen.Neoral (Cyclosporine) Common side effects may include decreased kidney function, shaking or tremors, increased risk of infections, increased cholesterol levels, sleep troubles, headache, nausea, high blood pressure, swollen gums, excessive hair growth, female fertility impairment, abdominal pain, diarrhea, nausea, leg cramps, numbness and tingling, dizziness, flushing, and increased risk of lymphoma.Zeposia (Ozanimod) Upper respiratory tract infections were a common reported side effect during clinical trials. Less common side effects included elevated liver enzymes, low blood pressure upon standing, frequent and painful urination, back pain, headaches, and high blood pressure.Xeljanz (Tofacitinib) Common side effects of this Janus kinase inhibitor include skin rash, shingles, high blood pressure, abnormal blood tests, headache, fever, nausea, diarrhea, vomiting, and cold symptoms like congestion, sneezing, and sore throat. In September 2021, the Food and Drug Administration (FDA) added a black box warning to this medicine for increased risk of heart attack, stroke, cancer, blood clots, and death — the latter two even at lower doses.
Biologic Therapy Side Effects
A newer type of therapy that is injected into the body, biologics are drugs derived from living cells or organisms like bacteria and yeast, and they stop certain proteins in the body from causing inflammation. A review published in January 2015 in the journal Gut and Liver notes that “the introduction of biologics for the treatment of IBD has changed the treatment paradigm for moderate to severe ulcerative colitis.” In the United States, the FDA has approved Remicade (infliximab), Humira (adalimumab), Simponi (golimumab), Entyvio (vedolizumab), and Stelara (ustekinumab) to treat ulcerative colitis. RELATED: The Pros and Cons of Biologics for Ulcerative Colitis While the benefits of biologic therapy typically far outweigh the risks in patients living with ulcerative colitis, there are some side effects to keep in mind:
RednessItchingBruisingPain or swelling at the injection siteHeadacheFever or chillsHives and other rashes
Biologics may also hinder the body’s ability to fight infections and have been associated with a small but measurable increased risk of lymphoma. In very rare instances, the use of biologics has been linked to changes in liver function.
Important Tips for Starting Any New Ulcerative Colitis Medication Regimen
To keep track of your symptoms and the potential side effects of treatment, you may want to keep a diary, and be sure to report any changes to your doctor. These symptom lists are not exhaustive, but sources like MedlinePlus from the National Library of Medicine can provide additional information for individual drugs. You should seek immediate medical attention if you develop signs of an allergic reaction: difficulty breathing, hives, or swelling of the face, lips, tongue, or throat. Finally, Wingate points out that a patient’s therapeutic needs may change over time. “What works now may not work at another stage of one’s disease,” she says. It’s crucial for patients to continuously discuss their condition with their gastroenterologist over time, so they can work together to decide which course of therapy is best and balance the benefits and risks of each treatment.
