Ulcerative Colitis Medication
Digestive HealthUlcerative Colitis

A Comprehensive Guide to Ulcerative Colitis Medications

A Comprehensive Guide to Ulcerative Colitis Medications
Tetiana Mykytiuk/iStock; Everyday Health
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Updated on November 21, 2025
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Medication is considered the foundation of treatment for ulcerative colitis (UC).

Your doctor will recommend one or more drugs, depending on your overall health, how severe the disease is, and other factors.

At first, the goal of treatment with medication will be to achieve remission by reducing the frequency and severity of symptoms, and by suppressing inflammation, until the lining of your colon (large intestine) has healed.

 Long-term management of UC with medication aims to resolve symptoms and improve your quality of life.

Medications may be given at first to quickly achieve remission. But during this time — the induction phase — your gastroenterologist will be starting or planning to start you on so-called maintenance medications to safely keep you in remission.

The following main classes of drugs are used to treat ulcerative colitis.

What Are the Medication Options for Ulcerative Colitis?

Ira Breite, MD, a gastroenterologist at Mount Sinai Health System, discusses ulcerative colitis medications.
What Are the Medication Options for Ulcerative Colitis?

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Aminosalicylates

This group of medications contains a chemical compound called 5-aminosalicylate acid. They work by decreasing inflammation in the lining of the gastrointestinal (GI) tract. This class includes the following drugs:

  • mesalamine (Lialda, Apriso, Canasa, Pentasa, Asacol HD, Delzicol, Rowasa)
  • sulfasalazine (Azulfidine)
  • olsalazine (Dipentum)
  • balsalazide (Colazal)
Mesalamine is typically one of the first drugs prescribed for mild to moderate UC.

Mesalamine is used both to treat active symptoms of UC and as a maintenance drug to prevent symptoms from recurring.

Mesalamine and other aminosalicylates may be taken orally as a tablet or capsule; mesalamine can also be taken rectally, as a suppository or in an enema. Depending on the formulation, it may be necessary to take up to three or four doses of the drug daily.

For ulcerative proctitis — when the disease is confined to your rectum — your doctor may prescribe a suppository or enema formulation alone.

For UC that extends beyond your rectum, your doctor may prescribe a suppository or enema as well as an oral formulation.

About 50 percent of people with UC achieve remission with rectal or oral aminosalicylates.

 Common side effects of mesalamine and other aminosalicylates include joint stiffness, headache, nausea, GI upset and pain, and rash.

 The same side effects are common in sulfasalazine, but it can also cause severe or even life-threatening allergic reactions or skin reactions. Another side effect of sulfasalazine is potential infertility in men, which may resolve when the medication is stopped.

Corticosteroids

These medicines, also known simply as steroids, are typically used orally while your medical team plans your transition to other therapies, or temporarily for very severe disease, to induce remission. They’re also used rectally in ulcerative proctitis. The American College of Gastroenterology no longer recommends steroids as a maintenance therapy to keep people in remission, however.

Steroids work to alleviate inflammation by suppressing the entire immune system. They may be taken orally, rectally, by injection, or intravenous (IV) infusion, and include the following drugs:

  • budesonide (Uceris)
  • prednisone
  • prednisolone (Millipred)
  • hydrocortisone (Cortef)
  • methylprednisolone (Medrol)
Budesonide is considered a first-line treatment in some cases of moderate active UC. It can be taken orally as a tablet, or rectally, as a foam, suppository, or in an enema.

 Because of the way the body processes budesonide, the oral form causes fewer side effects than other corticosteroids.

Due to their high risk of side effects, steroids other than budesonide are typically reserved for moderate to severe active UC. They also shouldn’t be taken for very long.

 If you take corticosteroids orally, by injection, or IV, you may have significant side effects, because they affect the whole body. Local steroids — which are applied directly to the area that needs treatment, such as inside the rectum — are generally the preferred option.

Possible side effects of steroids include:

For severe active UC, whether it’s the first instance of significant inflammation or a flare, hospitalization and high-dose IV corticosteroids are often required. Once remission is achieved, your dose of steroids will be tapered gradually and you’ll begin taking a different class of medication for maintenance.

Although rectal steroids don’t require a period of tapering off, most short courses of steroids require some tapering. Longer courses of steroids do need to be gradually tapered off, because these medications cause the body to reduce its production of the natural steroid cortisol. Discontinuing the medication too quickly can lead to a life-threatening complication caused by the lack of cortisol, called adrenal insufficiency.

 Steroids are dangerous as maintenance therapy to keep UC in remission, given the many side effects.

Once you start taking steroids, you and your doctor should also start talking about other, safer medications that may help bring this disease under control.

Immunomodulators

These drugs work by regulating or suppressing the immune system to inhibit inflammation at its source.

They’re usually reserved for cases in which aminosalicylates or steroids haven’t been effective enough. They may reduce or eliminate the need for steroids. Immunomodulators may be used alone or in combination to maintain remission in people for whom other drugs didn’t work, and some are used to help make other medications, like biologics, more effective.

Immunomodulators may take several months to start working. They include the following drugs:

  • cyclosporine (Gengraf, Neoral, Sandimmune)
  • azathioprine (Azasan, Imuran)
  • mercaptopurine (Purixan)
  • tacrolimus (Prograf)
Because immunomodulators modify the activity of the immune system, there is an increased risk of bacterial and viral infections.

 Before you begin a course of treatment using an immunomodulator, it’s important to get blood tests (complete blood count, liver function and enzyme, kidney function, glucose), and to screen for certain viruses. You’ll continue periodic monitoring with blood tests while taking the drug.

Biologics

Biologics act against inflammation-causing proteins that are part of your immune system response. Tumor necrosis factor (TNF) inhibitors are one type of biologic drug. Another type are integrin blockers, which stop inflammation-triggering white blood cells from entering the GI tract.

A third type of biologics used to treat UC are interleukin blockers. These drugs work by blocking the immune system proteins IL-12 and IL-23 (or IL-23 alone), which cause inflammation. They’re reserved for moderate to severe cases of UC, but are frequently used.

Biologics approved to treat UC include the following drugs:

  • infliximab (Remicade, Renflexis)
  • adalimumab (Humira)
  • golimumab (Simponi)
  • guselkumab (Tremfya)
  • vedolizumab (Entyvio)
  • ustekinumab (Stelara)
  • ustekinumab-aauz (Otulfi)
  • ustekinumab-aekn (Selarsdi)
  • ustekinumab-kfce (Yesintek)
  • ustekinumab-stba (Steqeyma)
  • ustekinumab-ttwe (Pyzchivia)
  • risankizumab-rzaa (Skyrizi)
  • mirikizumab-mrkz (Omvoh)
Like some other drugs for UC, biologics can increase your risk of infection. Allergic reactions are possible, or a reaction in which your body develops antibodies against the drug itself, removing it from the bloodstream. But if one of these drugs is controlling your UC symptoms without bothersome side effects, the benefits of continuing the drug often outweigh its risks.

Small Molecules

Small molecules are oral medications that also work on the immune system, but are synthetic and act differently from biologics. Because of their small size, they can be carried through the bloodstream to nearly any part of the body to work on the immune system directly.

Janus kinase (JAK) inhibitors like tofacitinib (Xeljanz) and upadacitinib (Rinvoq) suppress the immune system by blocking the JAK enzyme, thereby preventing it from activating inflammatory pathways in immune cells.

These drugs are used to treat moderate to severe UC.

 The U.S. Food and Drug Administration (FDA) has issued a warning about an increased risk of serious heart-related events such as heart attack and stroke, cancer, blood clots, and death with tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

Ozanimod (Zeposia) and etrasimod (Velsipity) are oral small molecule medications taken once daily for adults with moderate to severe UC, to treat active disease or for maintenance of remission. Ozanimod was the first in a class of drugs known as sphingosine 1-phosphate receptor (S1P) modulators.

Both ozanimod and etrasimod reduce the movement of lymphocytes, which are immune cells responsible for causing inflammation in the intestines. The drugs bind to receptors on the surface of the cells, helping prevent them from moving into the colon and causing damaging inflammation.

Other Medications

Your doctor may prescribe or recommend these other drugs and supplements for UC.

Antidiarrheal Medicines

While these drugs can help control diarrhea, they can also slow down your digestive function and increase your risk of toxic megacolon (enlarged colon), a severe complication. Because of these risks, antidiarrheal drugs should be used only under strict medical supervision.

Pain Relievers

Your doctor may recommend acetaminophen (Tylenol) for mild pain. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil or Motrin), naproxen (Aleve), and diclofenac (Voltaren), which can cause digestive upset and potentially worsen UC symptoms.

Iron Supplements

These supplements may be needed if you have chronic intestinal bleeding that results in a deficiency.

The Takeaway

  • Ulcerative colitis is primarily managed with medication, which aims to suppress inflammation and reduce the severity and frequency of symptoms.
  • The main classes of drugs used include aminosalicylates, corticosteroids, immunomodulators, biologics, and small molecules, with additional medications like pain relievers and iron supplements to support overall treatment.
  • Each drug class offers unique benefits and risks, and the choice of medication depends on disease severity and each individual’s health.

Resources We Trust

Additional reporting by Ashley Welch.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Lynch WD et al. Ulcerative Colitis. StatPearls. June 5, 2023.
  2. Ulcerative Colitis Treatment Options. Crohn’s & Colitis Foundation.
  3. Al Kazzi ES. The Updated ACG Guidelines to Manage Adult Ulcerative Colitis Patients. American College of Gastroenterology. August 19, 2025.
  4. Segal JP et al. Ulcerative Colitis: An Update. Clinical Medicine. March 2021.
  5. Medication Options for Ulcerative Colitis Treatment. Crohn’s & Colitis Foundation.
  6. Paridaens K et al. The Continuing Value of Mesalazine as First-Line Therapy for Patients With Moderately Active Ulcerative Colitis. Frontiers in Gastroenterology. June 2, 2024.
  7. Mesalamine (Oral Route). Mayo Clinic. September 1, 2025.
  8. Nakashima J et al. Mesalazine (USAN). StatPearls. February 15, 2024.
  9. Lynch WD et al. Ulcerative Colitis. StatPearls. June 5, 2023.
  10. 5-ASAs (Aminosalicylates). Crohn’s & Colitis UK. April 2023.
  11. Sulfasalazine. Memorial Sloan Kettering Cancer Center. December 12, 2022.
  12. Steroids. Crohn’s & Colitis UK. March 2023.
  13. Gros B et al. Ulcerative Colitis in Adults: A Review. Journal of the American Medical Association. September 12, 2023.
  14. Budesonide. MedlinePlus. March 15, 2024.
  15. Budesonide - Oral. Crohn’s & Colitis Foundation. February 1, 2023.
  16. Feuerstein JD et al. Appropriate Use and Complications of Corticosteroids in Inflammatory Bowel Disease: A Comprehensive Review. Clinical Gastroenterology and Hepatology. November 2025.
  17. Corticosteroids (Glucocorticoids). Cleveland Clinic. October 21, 2024.
  18. Claessen KMJA et al. Clinical Unmet Needs in the Treatment of Adrenal Crisis: Importance of the Patient’s Perspective. Frontiers in Endocrinology. July 19, 2021.
  19. Ulcerative Colitis: Diagnosis & Treatment. Mayo Clinic.
  20. Ferretti F et al. An Update on Current Pharmacotherapeutic Options for the Treatment of Ulcerative Colitis. Journal of Clinical Medicine. April 20, 2022.
  21. Venner JM et al. Immunomodulators: Still Having a Role? Gastroenterology Report. November 8, 2022.
  22. Biologics and Inflammatory Bowel Disease (IBD). University of Chicago Medicine.
  23. McDonald BD et al. IL-23 Monoclonal Antibodies for IBD: So Many, So Different? Journal of Crohn’s and Colitis. May 11, 2022.
  24. Treatment and Medication: Biotherapies. Crohn’s and Colitis Canada.
  25. Fact Sheet: Targeted Synthetic Small Molecules. Crohn’s & Colitis Foundation. June 2022.
  26. Padda IS et al. Tofacitinib. StatPearls. July 3, 2023.
  27. Padda IS et al. Upadacitinib. StatPearls. June 8, 2024.
  28. Al Kazzi ES. The Updated ACG Guidelines to Manage Adult Ulcerative Colitis Patients. American College of Gastroenterology. August 19, 2025.
  29. FDA Requires Warnings About Increased Risk of Serious Heart-Related Events, Cancer, Blood Clots, and Death for JAK Inhibitors That Treat Certain Chronic Inflammatory Conditions. U.S. Food and Drug Administration. December 7, 2021.
  30. Paik J. Ozanimod: A Review in Ulcerative Colitis. Drugs. August 22, 2022.
  31. Velcipity: Etrasimod. European Medicines Agency. September 12, 2025.
  32. Ulcerative Colitis. Cleveland Clinic. November 5, 2023.
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Yuying Luo, MD

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Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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