Medication is decided based on the severity or the extent of the illness. The National Health Insurance (Kela) pays lower special reimbursement (65 %) for most IBD medicines. You need a medical certificate to get the marking on your Kela card that gives you the reimbursement.
In self-directed treatment, medication is increased when symptoms appear following instructions that have been discussed with the doctor. The clinic is contacted if necessary.
5-ASA or mesalazine (Pentasa®, Asacol®) is an anti-inflammatory drug. It is used to prevent flare-ups. 5-ASA can be administered as pills or topically as suppositories or enemas.
The active ingredient in SASP or salazosulfapyridine (Salazopyrin ®) is mesalazine, which is transported to the large intestine by sulfapyridine. Sulfa may cause allergic reactions and have harmful effects on male fertility.
When the illness flares up, a treatment with cortisone (Prednison®, Lodotra®, Prednisolon®, Entocort®, Budenofalk®, Colifoam®, Solomet®, Solu-Medrol®, Medrol®) is often started either as tablets, rectal foam or for inpatients as injections or infusions. Cortisone alleviates inflammation and usually eases the symptoms quickly, but it also has an immunosuppressive effect. Long-term use is not recommended due to side effects.
Immunosuppressive medication (Imurel®, Sandimmun®, Mercaptopurin Orion®) is used if 5-ASA or cortisone medication do not work. The response to immunosuppressive medication develops slowly during 3-6 months, and the treatment is continued at least 3-5 years.
Biologic medications (Humira®, Simponi®, Remicade®, Entyvio®, Remsima®, Inflectra®) can be used to treat severe ulcerative colitis. They affect inflammation transmitters or block the white blood cells that maintain inflammation. Some biologic medications are given as infusions in hospitals, others are injected at home. Biosimilars are precise copies of biologic medicines and have similar safety and efficacy profiles.
Probiotics combined with 5-ASA or SASP have been found to be beneficial in the maintenance treatment of ulcerative colitis.
Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen or ketoprofen can aggravate ulcerative colitis and increase bleeding. Paracetamol is a safer option to use for fever and as painkiller.
In pediatric ulcerative colitis, the same medications are used as for grown-ups. However, issues such as the effect on growth need to be taken into account when choosing medication.