Merck Manual

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Drugs That Reduce Bowel Inflammation Caused by Ulcerative Colitis

Drugs That Reduce Bowel Inflammation Caused by Ulcerative Colitis

Drug

Some Side Effects

Comments

Aminosalicylates

  • Sulfasalazine

Common: Nausea, headache, dizziness, fatigue, fever, rash, and, in men, reversible infertility

Uncommon: Inflammation of the liver (hepatitis), pancreas (pancreatitis), or lung (pneumonitis) and hemolytic anemia

Abdominal pain, dizziness, and fatigue are related to dose.

Hepatitis and pancreatitis are unrelated to dose.

  • Balsalazide

  • Mesalamine

  • Olsalazine

Common: Fever and rash

Uncommon: Pancreatitis, inflammation of the pericardium (pericarditis), and pneumonitis

For olsalazine: Watery diarrhea

Most side effects seen with sulfasalazine may occur with any of the other aminosalicylates but much less frequently.

Corticosteroids

Prednisone

Diabetes mellitus, high blood pressure, cataracts, osteoporosis (decreased bone density), thinning of skin, mental problems, acute psychosis, mood swings, infections, acne, excessive body hair (hirsutism), menstrual irregularities, gastritis, and peptic ulcer disease

Diabetes and high blood pressure are more likely to occur in people who have other risk factors.

Budesonide

Diabetes mellitus, high blood pressure, cataracts, and osteoporosis

Budesonide causes the same side effects as prednisone but to a lesser degree.

Hydrocortisone (enema or foam)

Some of the drug is absorbed by the body, but even with long-term use, few people have serious side effects (unlike with corticosteroids such as prednisone).

Hydrocortisone enema or foam is mainly for ulcerative colitis affecting the rectum or large intestine near the rectum.

Immunomodulators

  • Azathioprine

  • Mercaptopurine

Anorexia, nausea, vomiting, general feeling of illness, infection, cancer, allergic reactions, pancreatitis, low white blood cell count, bone marrow suppression, and liver dysfunction

Side effects that are usually dose dependent include bone marrow suppression and liver dysfunction.

Interval blood monitoring is required.

Cyclosporine

High blood pressure, nausea, vomiting, diarrhea, kidney failure, tremors, infections, seizures, neuropathy, and development of lymphomas (cancers of the lymphatic system)

Side effects become more likely with long-term use.

Tacrolimus

Similar to cyclosporine

This drug is closely related to cyclosporine and shares a number of its side effects.

Biologic and related agents

Infliximab

Infusion reactions, infections, cancer, abdominal pain, liver dysfunction, and low white blood cell count

Infusion reactions are potentially immediate side effects that occur during the infusion (such as fever, chills, nausea, headache, itching, rash, hives, decreased blood pressure, or difficulty breathing).

People should be screened for tuberculosis and hepatitis B before initiating treatment.

Adalimumab

Pain or itching at the injection site (hypersensitivity reactions), headache, infections, and cancer

Side effects are similar to infliximab except adalimumab is given under the skin (subcutaneously) and so does not cause infusion reactions.

Other hypersensitivity reactions that occur at the injection site include rash and hives. More severe hypersensitivity reactions are possible.

Golimumab

When given subcutaneously, pain or itching at the injection site (hypersensitivity reactions), infections, and cancer

Side effects are similar to infliximab.

When given subcutaneously, this drug does not cause infusion reactions.

Other hypersensitivity reactions that occur at the injection site include rash and hives. More severe hypersensitivity reactions are possible.

Tofacitinib

Diarrhea, increased cholesterol levels, headache, herpes zoster (shingles) infection, cold-like symptoms, rash, upper respiratory infection, and pulmonary embolism

People should be screened for tuberculosis before starting treatment.

Vedolizumab

Infections, hypersensitivity reactions, common colds

Ustekinumab

Injection site reactions (pain, redness, swelling), cold-like symptoms, chills, headache, tired feeling, diarrhea, lower back pain, painful urination, or rash or itching

This drug might increase the risk of cancer. Squamous cell carcinoma, a type of skin cancer, may occur.

A disorder that causes the brain to swell (reversible posterior leukoencephalopathy syndrome) may occur.