5-ASA medications
Medications for symptoms


Biologic response modifiers, or biologics, are a group of medications for ulcerative colitis.

The following biologics are available in Canada to treat ulcerative colitis:

Biologics used to treat ulcerative colitis work by binding to and inactivating a molecule called tumour necrosis factor alpha (TNF-alpha or TNF-α). TNF-alpha is involved in causing the inflammation that is a key part of ulcerative colitis.

Infliximab is used to treat people with moderate to severe ulcerative colitis when patients have not responded to other treatments. Infliximab is given as an intravenous (IV - meaning into a vein) infusion. Infusions are given at infusion clinics under the supervision of a health professional. The infusion procedure usually takes a few hours to complete.

The most common side effects of infliximab include allergic reactions and infusion-related reactions (e.g., shortness of breath, flushing, headache, rash). Serious infections may occur in people taking infliximab, as this medication can lower your ability to fight off infection.

Tuberculosis is one of the serious infections that patients taking infliximab are at greater risk of compared to the general population. For this reason, people are assessed for their risk of tuberculosis before starting treatment.

Infliximab may also increase the risk of developing tumours and certain types of cancer. Rarely, people have developed cancer, including non-melanoma skin cancer and lymphoma (cancer that affects white blood cells in the lymph system). Very rarely, an often-fatal form of lymphoma called hepatosplenic T-cell lymphoma has occurred in people using infliximab along with medications, azathioprine or 6-mercaptopurine.

Your doctor may recommend regular blood tests and checkups while you are taking this medication. Ask your doctor what side effects you should watch out for and which need to be reported to your doctor.

5-ASA medications

5-ASA medications work directly on the bowel lining, where they reduce inflammation. The exact way by which they reduce inflammation is unclear. They are used to treat symptoms of an ulcerative colitis attack and to help keep the condition in remission.

The following 5-ASA (5-aminosalicylic acid) medications are available in Canada:

These 5-ASA medications are available in various forms, including pills, enemas, and suppositories. Each medication has a slightly different formulation that allows it to reach different areas of the bowel.

Side effects may include nausea, vomiting, loss of appetite, diarrhea, abdominal pain, skin rash, gas, or headaches. Serious side effects include bone marrow suppression (which may change blood cell levels and may increase the risk of infection), heart problems (i.e., inflammation of the muscle surrounding the heart), kidney and liver damage, and allergic reactions.

People allergic to sulfa medications should avoid sulfasalazine, and those allergic to ASA should avoid 5-ASA medications.

Your doctor may recommend that you get regular blood tests and checkups while taking 5-ASA.


Corticosteroids work by reducing inflammation. They are used to treat the symptoms of an ulcerative colitis attack and are used for people with moderate to severe ulcerative colitis.

The following corticosteroids are available in Canada to treat ulcerative colitis:

These corticosteroids are available in various forms, including pills, injections, enemas, suppositories, and rectal foams. People who are allergic to corticosteroids should avoid them.

Side effects include increased appetite, weight gain, menstrual changes, stomach irritation, indigestion, muscle cramps, skin rash, fast or irregular heartbeats, and blurred vision. Serious side effects include new infections, masking the signs of infection, growth suppression in children, and, over prolonged use, eye problems such as cataracts and glaucoma.

If you will be using corticosteroids over the long term, your doctor may recommend regular checkup appointments and lab tests.

Don't stop taking corticosteroids suddenly - ask your doctor or pharmacist how to safely stop the medication. Let all health professionals involved in your care know that you are using corticosteroids.

Medications for symptoms

A variety of other medications are also used by people with ulcerative colitis, including:

  • antimicrobials to treat bowel infections (e.g., metronidazole, ciprofloxacin)
  • anti-diarrhea medications (e.g., loperamide)
  • nutritional supplements (e.g., vitamins and minerals)
  • pain relievers (e.g., acetaminophen)
  • medications to treat or prevent osteoporosis (e.g., calcium and vitamin D, alendronate, etidronate, risedronate, raloxifene, teriparatide, calcitonin)