Ulcerative colitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The first step in the management of an acute ulcerative colitis attack involves determining the anatomical extent of the disease endoscopically, and the severity of the disease, clinically. This classification is important to determine the necessity for topical (in distal disease) or systemic (in extensive disease) pharmacotherapy. Additionally, the severity of the disease may help determine the prognosis and the requirement for more aggressive intervention. Once the disease goes into remission, the goal of maintenance therapy is to prevent any subsequent acute exacerbations.
Medical Therapy
Standard treatment for ulcerative colitis depends on extent of involvement and disease severity. The goal is to induce remission initially with medications, followed by the administration of maintenance medications to prevent a relapse of the disease. The concept of induction of remission and maintenance of remission is very important. The medications used to induce and maintain a remission somewhat overlap, but the treatments are different. Physicians first direct treatment to inducing a remission which involves relief of symptoms and mucosal healing of the lining of the colon and then longer term treatment to maintain the remission.
Pharmacotherapies
Aminosalicylates
Sulfasalazine has been a major agent in the therapy of mild to moderate UC for over 50 years. In 1977 Mastan S.Kalsi et al determined that 5-aminosalicyclic acid (5-ASA and mesalazine) was the therapeutically active compound in sulfasalazine. Since then many 5-ASA compounds have been developed with the aim of maintaining efficacy but reducing the common side effects associated with the sulfapyridine moiety in sulfasalazine.[1]
- Mesalazine, also known as 5-aminosalicylic acid, 5-ASA, Asacol, Pentasa and Mesalamine.
- Sulfasalazine, also known as Azulfidine.
- Balsalazide, also known as Colazal.
- Olsalazine, also known as Dipentum.
Corticosteroids
Immunosuppressive drugs
- Mercaptopurine, also known as 6-Mercaptopurine, 6-MP and Purinethol.
- Azathioprine, also known as Imuran, Azasan or Azamun, which metabolizes to 6-MP.
- Methotrexate, which inhibits folic acid
- Tacrolimus
Biological treatment
Contraindicated medications
Ulcerative colitis is considered an absolute contraindication to the use of the following medications:
- Alosetron
- Dicyclomine
- Glycopyrrolate
- Hyoscyamine
- Methscopolamine bromide
- Loperamide
- Reserpine
- Streptokinase
References
- ↑ S. Kane (2006). "Asacol - A Review Focusing on Ulcerative Colitis".