Challenges and opportunities in the treatment of ulcerative colitis

Table 1 Allopatic drugs used for the treatment of ulcerative colitis and their side effects

Drug	Use	Dosage form	Disadvantages	Ref.
5-aminosalicylic acid compounds	Treatment of tissue inflammation	Enema or orally	Enema solution cannot reach high enough to treat inflammation in the upper colon and if taken orally, however, the stomach and upper small intestine absorb most of the drug before it reaches the colon	[13]
Sulfasalazine	Decreasing intestinal inflammation and relieving symptoms of abdominal pain, diarrhea, and rectal bleeding	Orally	Nausea, heartburn, headache, anemia, skin rashes, and in rare instances, hepatitis and kidney inflammation. In men, sulfasalazine can reduce the sperm count	[14]
Olsalazine (consists of two 5-ASA molecules linked together)	Decreasing intestinal inflammation and relieving symptoms of abdominal pain, diarrhea, and rectal bleeding	Orally	Secretory diarrhea	[15]
Corticosteroids (prednisone, prednisolone, hydrocortisone, etc.)	Corticosteroids do not require direct contact with inflamed intestinal tissues to be effective. These are potent anti-inflammatory agents	Orally, intravenous	Some patients become corticosteroid dependent and consistently develop symptoms of colitis Whenever the corticosteroid dose is below a certain level. Common side effects include rounding of the face (moon face), acne, increased body hair, diabetes, weight gain, high blood pressure, cataracts, glaucoma, increased susceptibility to infections, muscle weakness, depression, insomnia, mood swings, personality changes, irritability, and thinning of bones (osteoporosis) with an accompanying increased risk of compression fractures of the spine. Children on corticosteroids can experience stunted growth	[16]
Immunomodulator medications	Immunomodulators decrease tissue inflammation by reducing the population of immune cells and/or by interfering with their production of proteins that promote immune activation and inflammation	Orally	Risks of infection due to weakened immunity	[17]
Azathoprine and 6-Mercaptopurine	These are used mainly in the following situations, UC and CD patients with severe diseases not responding to corticosteroids, patients experiencing undesirable corticosteroid-related side effects, patients dependent on corticosteroids and unable to discontinue them without developing relapses		Increased vulnerability to infections, inflammation of the liver (hepatitis) and pancreas (pancreatitis), and bone marrow toxicity (interfering with the formation of cells that circulate in the blood). 6-MP can reduce the sperm count in men When the partners of male patients on 6-MP conceive, there is a higher incidence of miscarriages and vaginal bleeding. There also are respiratory difficulties in the newborn	[18]
Methotrexate	Helpful in treating patients with moderate to severe CD who neither respond to 6-MP and azathioprine nor tolerate these two medications	Orally or intramuscular	Development of liver cirrhosis when the medication is given over a prolonged period of time (years). Low white blood cell counts and inflammation of the lungs. Methotrexate should not be used in pregnancy	[19]
Cyclosporine	Treatment of severe UC. It is useful in fulminant UC and severely ill patients who do not respond to systemic corticosteroids	Orally as well as intravenously	High blood pressure, renal function impairment, tingling sensations in the extremities, anaphylactic shock and seizures	[20]

5-ASA: 5-aminosalicylic acid; UC: Ulcerative colitis; CD: Crohn’s disease.