Coping with Ulcerative Colitis Treatment Side Effects

Ulcerative colitis is an inflammatory bowel disease (IBD). People with ulcerative colitis have an overactive immune system that attacks and inflames the large intestine, including the colon and rectum. Inflammation leads to symptoms, such as belly cramps, diarrhea, and fatigue.

There’s no cure for ulcerative colitis, but treatment can help manage symptoms and prevent flare-ups.

Some of the medications doctors recommend to treat ulcerative colitis work by calming the immune system to reduce inflammation. Other treatments relieve specific symptoms, such as diarrhea or bloating.

Common medications used to treat ulcerative colitis symptoms include:

• antidiarrheal drugs: loperamide (Imodium)
• pain relievers: acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve)
• aminosalicylates: sulfasalazine, balsalazide, mesalamine, olsalazine
• corticosteroids: prednisone, prednisolone, methylprednisolone, budesonide
• immunomodulators: azathioprine, cyclosporine, tacrolimus, 6-mercaptopurine (6-MP), methotrexate
• biologic drugs: adalimumab (Humira), infliximab (Remicade)
• janus kinase (JAK) inhibitors: tofacitinib (Xeljanz)
• antibiotics: ciprofloxacin (Cipro), metronidazole (Flagyl), rifaximin (Xifaxan)

These medications can cause mild to severe side effects. Your doctor will help you find a treatment that minimizes ulcerative colitis symptoms with side effects you can tolerate.

It’s essential to discuss your symptoms with your doctor. Your treatment needs may change over time.

Which drugs can cause it: aminosalicylates, antibiotics, immunomodulators

How to manage it: Ask your doctor about trying an over-the-counter (OTC) antidiarrheal medication or an antispasmodic drug to reduce movement and pain in the bowel. Drink extra fluids to replace what you lose from diarrhea.

Consider keeping a food diary to figure out which foods cause the most symptoms. Avoid foods that make symptoms worse. These often include:

• spicy or fatty foods
• high fiber foods, such as whole grains and some vegetables and fruits
• dairy
• caffeine

Which drugs can cause them: aminosalicylates, antibiotics, biologics, corticosteroids, immunomodulators, JAK inhibitors

How to manage it: Research suggests that migraine is more common in people with IBD, possibly linked to inflammation. You may find that your migraine attacks or headaches actually improve when you begin treatment for ulcerative colitis.

An OTC pain reliever, such as acetaminophen, can relieve the occasional headache. If you get headaches often, ask your doctor if you need to reduce the dose of your ulcerative colitis medication or switch to another medication.

Let your doctor know if you have a sudden severe headache. It may be linked to a more serious condition.

Which drugs can cause it: aminosalicylates, antibiotics, immunomodulators

How to manage: Several tips can help you manage heartburn, such as:

• Avoid foods, such as citrus, alcohol, and chocolate, that can irritate your esophagus and make heartburn worse.
• Avoid smoking.
• Avoid eating close to bedtime.
• Don’t lie down right after you eat.

Always talk with your doctor before taking OTC heartburn medications, including proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs).

This can include hives, redness or discoloration, itching, rash, and swelling of the lips and throat.

Which drugs can cause them: biologics

How to manage: Rashes, itchy skin, flushing, and swelling that occur during or within 24 hours of an IV infusion are known as infusion reactions. Other symptoms may include:

• chest discomfort
• high blood pressure
• muscle pain
• nausea
• headache
• dizziness

Infusion reactions are usually mild to moderate in severity and manageable with medications. The healthcare professional who gives you the infusion should monitor you for symptoms and treat you if a reaction occurs.

Which drugs can cause them: aminosalicylates, immunomodulators, biologics, corticosteroids, JAK inhibitors, antibiotics

How to manage: Many of these medications can reduce your protective immune response. Antibiotics also throw off the balance of good and bad bacteria in your body. These factors can put you at an increased risk for respiratory, urinary tract, and intestinal infections.

Make sure you’re up to date on all your vaccinations, including those for the flu, pneumonia, and shingles. Report any signs of infection to your doctor, such as:

• fever
• cough
• pain when you urinate
• bloody stools, diarrhea, abdominal pain, and cramping, which can be signs of a Clostridium difficile (C. diff) infection

Which drugs can cause them: antibiotics, corticosteroids, immunomodulators

How to manage: Medications used to treat ulcerative colitis may cause sleep problems. IBD has also been linked to sleep disturbances.

Ulcerative colitis symptoms can make it harder to sleep. Poor sleep may also raise inflammation in the body linked to conditions, such as ulcerative colitis.

The following tips can improve sleep.

• Consider some physical activity every day.
• Go to bed around the same time every night.
• Avoid heavy meals and screen time before bed.
• Ask your doctor if you can take your medication earlier in the day so it doesn’t interfere with your sleep.

Which drugs can cause it: corticosteroids

How to manage: Weight gain is a common side effect of corticosteroids. It often occurs in the face, back of the neck, and abdomen.

You should begin to lose weight once you stop taking steroid drugs. While you’re still on this medication, watch your calories and engage in physical activity regularly to prevent excess weight gain.