Drugs for ulcerative colitis
Ulcerative colitis is initially treated with medication both in the non-inflammatory phase and in the acute inflammatory episode. The choice of drug depends on the reason for the therapy and the severity of the disease. Because there are different drug groups with different anti-inflammatory effects, the therapy can be designed very individually. By combining the drugs, the therapy can be adjusted accordingly, should a single medication not be sufficiently effective.
What drug groups are there?
The drugs used in ulcerative colitis can be divided into three broad groups. There are the so-called aminosalicylates, which are also called 5-ASA preparations, glucocorticoids and the large group of immunosuppressants.
Furthermore, a distinction must be made between whether the drugs are used to treat an acute attack or to maintain the inflammation-free interval. Salofalk® (Mesalazine) is the most frequently used drug in the group of aminosalicylates. It can be used both to maintain the inflammation-free phase and for mild to moderate attacks.
Glucocorticoids, such as the drug budesonide, are used either locally as a suppository or through the vein for stronger attacks. Because of the many side effects of glucocorticoids, including cortisone, therapy with glucocorticoids should only be carried out for limited periods of time and is therefore not suitable for maintaining the non-inflammatory phase.
Finally there are the immunosuppressants. This group includes various drugs and also antibodies that downregulate the inflammatory response in the body. Two of the immunosuppressants can be used in maintenance therapy. These are azathioprine, a drug that downregulates DNA synthesis, and the antibody Remicarde®. Otherwise the immunosuppressants are more likely to be used in the therapy of a severe episode.
Read more on the subject at: Immunosuppressants
Salofalk® is also called mesalazine and belongs to the group of aminosalicylates. It has anti-inflammatory effects in the intestines and downregulates the immune system. Salofalk® can be administered in different forms. Tablets are specially coated so that they reach sections of the intestine further downwards and still have an effect there. This is important because ulcerative colitis typically shows an involvement of the rectum, which then continuously spreads upwards. Salofalk® can therefore also easily reach the affected regions in the form of a suppository or as a foam preparation. Salofalk® is used both in flare-up therapy, especially for light flare-ups, and as maintenance therapy in the non-inflammatory phase.
As with any other medication, allergic reactions can occur when taking Salofalk®. These can manifest as rashes or even fever and difficulty breathing. In addition, the drug in rare cases can lead to a decrease in white blood cells, with which serious infections are favored. It is therefore advisable to take a blood sample with a complete blood count after a certain period of time, when the drug has been reapplied. If pain occurs in the mouth or throat area and a deterioration in the state of health is perceived, the intake of Salofalk® should be stopped.
Remicarde® is the trade name of an antibody infliximab, which is directed against tumor necrosis factor alpha. This tumor necrosis factor alpha plays an important role in the inflammatory response. By inhibiting this factor with Remicarde®, the inflammatory reaction can be inhibited.
Remicarde® is only used in ulcerative colitis when there is a severe flare-up and in rarer cases as maintenance therapy. The reason for this is that the antibody has a number of limitations and side effects. Surgical therapy should be discussed before using Remicarde or other medication that may only be used in severe relapses. Remicarde® must not be given to pregnant women or patients on immunosuppressive therapy. Infections also speak against the use of the antibody. This includes acute infections, but also chronic infections such as tuberculosis. This could be reactivated again. Remicarde® must not be used if you have cancer or a serious heart disease associated with reduced pumping capacity.
The side effects include flu-like symptoms such as headache and body aches, as well as fever. The antibody can have a negative impact on all blood cells, so exhaustion, frequent infections and spontaneous bleeding must be expected.
Read more on the subject at: Infliximab
Cortisone belongs to the group of glucocorticoids. It is also similar to cortisone, which is produced by the body. Like Salofalk®, it can either be taken as a tablet or in the form of a foam. Cortisone is an important drug for relapse therapy because it has anti-inflammatory effects. If the effect of the tablets or local therapy is insufficient, cortisone can be given via the vein, which has a better effect. It is important that cortisone may only be given for a limited period of time, otherwise the side effects will predominate. The classic therapy scheme is initially a short, high-dose administration of cortisone (cortisone surge) followed by a slow tapering off of the drug.
Read more on the subject at: Cortisone
What drugs are used for an episode?
Which drugs are used in the flare-up depends on the severity of the individual flare-up. A slight flare-up without a fever and only a few bloody diarrhea can in most cases be treated well with Salofalk alone. Salofalk® (mesalazine) can be given in the form of tablets or as a suppository or foam inserted into the rectum.
In the case of a moderate episode, which can sometimes be accompanied by fever and a clear feeling of illness, therapy with glucocorticoids, such as cortisone, is extended. Usually, people start with tablets or local procedures before increasing therapy further. Glucocorticoids via the vein are used for severe relapses.
The severe episode is characterized by fever and more than six diarrhea a day. In addition, the heart rate is increased. In the event of a severe thrust, Salofalk® is more likely not to be given, as it does not have a sufficient effect. If there is no improvement in the symptoms with cortisone alone, various immunosuppressants can be considered. This includes the Remicarde® antibody and the group of calcineurin inhibitors. The calcineurin inhibitors inhibit calcineurin, which plays an important role in the activation of the inflammatory cells.
General information can be found at: Relapse in ulcerative colitis
What can I do if the medication doesn't help?
If the drug therapy is exhausted and is no longer profitable, surgical therapy should be considered. With a so-called proctocolectomy, ulcerative colitis can even be cured. During this operation, the entire colon and also the rectum are removed. A pocket is formed from part of the small intestine as a new reservoir for the stool, which is then connected to the anus so that stool continence is maintained. So that the new connection can heal in peace, an artificial anus is created over a limited period of time, which can easily be moved back after the healing phase. The operation is used not only when the drugs no longer work, but also when complications arise. These are, for example, a tear in the intestine or a life-threatening expansion of the large intestine.
In addition to the operation, there is the possibility of a type of dialysis to remove the excess immune cells, as these continue to maintain the inflammation. This procedure is only used in Germany in rare individual cases.
Further information on the topic can be found at: Therapy of ulcerative colitis
Are there any over-the-counter medications?
The drugs of the normal therapy regimen are all prescription-only. Since many of the drugs, especially cortisone and immunosuppressants, can trigger serious side effects, they should only be prescribed by doctors. This enables the attending physician to regularly monitor the patient's symptoms, since ulcerative colitis is a serious threat in the flare-up.
Alternative medical preparations, such as frankincense extracts, can also be obtained online without a prescription. However, such therapeutic methods should only be used within studies, as they have not yet been sufficiently tested.
At this point you can also read the main page on the promising medicinal plant soft smoke: What is the use of soft smoke?
What do you have to consider when stopping the medication?
Salofalk® can theoretically be discontinued without any further measures. Nonetheless, weaning should be carefully considered, as Salofalk® helps to minimize inflammation in the gastrointestinal tract. Stopping the drug increases the risk of an inflammatory flare-up.
With cortisone, it is very important that the drug should not be stopped suddenly. While the cortisone is being taken, the body's own cortisone production in the adrenal gland is suppressed by a complex control circuit. If you stop taking cortisone too quickly, the adrenal gland cannot start producing quickly enough and there could be a shortage of cortisone. Immunosuppressants may also only be discontinued in a controlled manner by a doctor, as the suppression of the immune system is suddenly lifted and this leads to an inflammatory reaction.