Tips for Coping with Ulcerative Colitis Treatment Side Effects

Which drugs can cause it: corticosteroids, immunomodulators

How to manage it: Acne should clear up once you stop taking the medication. Your doctor may prescribe an acne cream or antibiotics to control skin problems in the meantime.

Which drugs can cause it: antibiotics, corticosteroids

How to manage it: If these symptoms bother you, talk to your doctor. They may need to adjust your dose.

Which drugs can cause it: aminosalicylates, antibiotics, immunomodulators, corticosteroids

How to manage it: Abdominal pain and nausea linked to ulcerative colitis symptoms and medications can make you lose your appetite. That can make it hard to get enough of the nutrients you need.

Work with your doctor or a dietitian to ensure that you’re getting enough calories. Try to eat a variety of nutrient-dense and nutritious foods when you’re hungry.

Which drugs can cause it: aminosalicylates, antibiotics, biologics, immunomodulators

How to manage it: Ask your doctor whether you should take your medication on a full stomach or with food to prevent stomach irritation.

Which drugs can cause it: aminosalicylates, immunomodulators

How to manage it: The following tips can help to ease constipation:

• Drink extra water so stools are softer and easier to pass.
• Exercise regularly to keep stools moving through your colon.
• Talk to your doctor or a nutritionist about foods that you can eat that will help keep you regular without causing ulcerative colitis symptoms.
• Ask your doctor if you should take a laxative or stool softener.

Which drugs can cause it: aminosalicylates, antibiotics, immunomodulators

How to manage it: Ask your doctor about trying an over-the-counter (OTC) antidiarrheal medicine 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 it: aminosalicylates, corticosteroids, immunomodulators, biologics

How to manage it: When you’re feeling dizzy:

• Sit or lie down in a dark and quiet room until the dizziness goes away.
• Keep your head raised with two or more pillows when you sleep at night.
• Avoid activities that could be dangerous, like driving or operating heavy machinery.

If the dizziness persists, ask your doctor if you should change medications.

Which drugs can cause it: aminosalicylates

How to manage it: Use a prescription or OTC mouth rinse or artificial saliva product to add moisture to your mouth.

If dry mouth continues to bother you, ask your doctor whether you can adjust your medication dose or switch to a drug that doesn’t cause this side effect.

Which drugs can cause it: aminosalicylates, immunomodulators

How to manage it: Limit or avoid foods that worsen gas. These may include:

• high fiber vegetables (broccoli, Brussels sprouts, cabbage)
• high fiber whole grains like bran
• dairy products
• fatty or fried foods
• refined and sugary foods
• artificial sweeteners

Talk to your doctor about taking an OTC gas remedy that contains simethicone.

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, possible 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 like 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 drug.

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 to manage heartburn:

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

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

This can include hives, redness, 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. Your healthcare provider who gives you the infusion should monitor you for symptoms and treat you if a reaction occurs.

This may involve redness, swelling, itching, and pain.

Which drugs can cause them: biologics

How to manage them: Symptoms usually clear up on their own. Call your healthcare provider if they don’t improve.

Which drugs can cause it: aminosalicylates, biologics, immunomodulators

How to manage it: A heating pad or OTC pain reliever may help with joint or muscle pain in the short term. If it continues, ask your doctor whether you should adjust or change your medications.

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

How to manage them: The following tips can help reduce nausea and vomiting:

• Take your medication with food.
• Eat several small meals throughout the day rather than three large meals.
• Eat slowly and try to avoid activity after you eat.
• Choose bland foods like crackers and toast.
• Avoid greasy, fried, or sweet foods.
• Drink water or ginger ale to stay hydrated.

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

How to manage: Many of these drugs 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 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 of the following signs of infection to your doctor:

• 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 itself 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 like ulcerative colitis.

The following tips can improve sleep:

• Try to exercise a bit 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 them: Both corticosteroids and ulcerative colitis itself have been linked to bone loss. To support strong bones:

• Eat a healthy diet rich in vitamin D and calcium.
• Do weight bearing exercises like walking and resistance training.
• Avoid smoking and limit alcohol use, which can weaken your bones.
• Ask your doctor if you should take calcium and vitamin D supplements to strengthen your bones.

Your doctor may also recommend a bone density test. If you have low bone density, you may need to take bone-strengthening medication, such as alendronate (Fosamax) or denosumab (Prolia).

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 start to lose weight once you stop taking steroid drugs. While you’re still on this medication, watch your calories and exercise regularly to prevent excess weight gain.

Feel empowered to ask questions each time your doctor prescribes a new treatment for ulcerative colitis. Find out how the medication will help you and what side effects it might cause. Also, you can find out which side effects warrant a call or visit to your doctor’s office.

Many of the side effects on this list will go away once your body gets used to the drug. Let your doctor know if any of these problems persist or bother you. They may change your dose or switch you to another medication that doesn’t cause the same side effects.