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Medications Associated With Ulcerative Colitis: Risk Factors and Treatment Options

Prescription and non-prescription drugs used for pain, infections, skin conditions, and immune disorders have been studied for potential links to ulcerative colitis. 

This guide summarizes which medication categories appear most frequently in research, outlines known risk mechanisms, and highlights current treatment options for patients managing UC symptoms.

Medications Linked to Ulcerative Colitis

Research over the years has pointed to several classes of medications that may trigger or exacerbate UC, especially in people who may already be genetically predisposed. These include:

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Diclofenac
  • Indomethacin

NSAIDs may disrupt the gut lining, making it more susceptible to inflammation and ulcers.

2. Antibiotics:

  • Amoxicillin
  • Ciprofloxacin
  • Clindamycin
  • Azithromycin

Frequent antibiotic use may alter gut microbiota in ways that promote inflammation, which can trigger or worsen ulcerative colitis symptoms.

3. Oral Contraceptives:

  • Combination estrogen-progestin birth control pills (e.g., Yasmin, Ortho Tri-Cyclen)

Several studies have shown an increased risk of inflammatory bowel disease (IBD), including UC, in long-term oral contraceptive users.

4. Isotretinoin (Accutane):

  • Commonly prescribed for severe acne, this medication has been linked to a higher risk of UC in some users.

5. Biologic and Immune-Modulating Medications:

  • Interferon therapies
  • Certain cancer immunotherapies (like checkpoint inhibitors)
  • TNF inhibitors (e.g., Enbrel) in rare paradoxical cases

While many biologics are used to treat UC, some can paradoxically cause IBD-like symptoms in certain individuals.

Top Treatments for Ulcerative Colitis: Biologics and Beyond

If you or someone you love is dealing with ulcerative colitis, there is hope. Several cutting-edge treatments are available to manage symptoms and help achieve long-term remission.

Here are some of the most promising and widely used ulcerative colitis medications, including some similar to Tremfya (guselkumab) and Velsipity (etrasimod):

1. Tremfya Alternatives (IL-23 Inhibitors):

  • Skyrizi (risankizumab): FDA-approved for Crohn’s disease and being studied for UC.
  • Stelara (ustekinumab): Blocks both IL-12 and IL-23; approved for UC and Crohn’s.
  • Mirikizumab (Omvoh): IL-23 inhibitor recently FDA-approved for moderate-to-severe UC.

2. Velsipity Alternatives (S1P Receptor Modulators):

  • Zeposia (ozanimod): Same class as Velsipity, approved for UC with a favorable safety profile.
  • Etrasimod (Velsipity): Newly approved S1P modulator for moderate-to-severe UC.

3. Other Top Biologic and Targeted Therapies:

  • Humira (adalimumab): A TNF inhibitor widely used for UC.
  • Entyvio (vedolizumab): Gut-specific integrin blocker, highly effective for UC with fewer systemic side effects.
  • Remicade (infliximab): Another TNF inhibitor often used when others fail.
  • Xeljanz (tofacitinib): A JAK inhibitor, used for moderate-to-severe UC.
  • Rinvoq (upadacitinib): A newer JAK inhibitor also showing strong results for UC.

These therapies vary in mechanism and effectiveness, so treatment plans should always be customized with the help of a gastroenterologist.

Conclusion

While medications are often a lifeline, it's crucial to stay informed about the potential risks they carry — especially when it comes to chronic inflammatory diseases like ulcerative colitis. Understanding which drugs may increase your risk can help you make better choices for your long-term health. And if you’re already living with UC, the growing list of advanced therapies offers new hope for relief and remission.

Always consult with your healthcare provider before starting or stopping any medication, especially if you’re managing or at risk for ulcerative colitis.

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