Switching Medications: What to Do if Ulcerative Colitis Treatment Isn’t Working
Health ConditionsDigestive HealthUlcerative Colitis

Switching Medications: What to Do if Ulcerative Colitis Treatment Isn’t Working

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Published on February 24, 2026
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T he goal of ulcerative colitis (UC) treatment is twofold: to heal the inflamed mucosal lining of the gut and to eliminate symptoms such as cramping and pain (usually once the inflammation subsides). Sometimes it takes a few tries to find a medication that does the trick.

“Many patients require at least one treatment adjustment,” says Anita Afzali MD, MPH, a gastroenterologist who specializes in inflammatory bowel disease and is the James F. Heady endowed chair and professor of medicine at the University of Cincinnati College of Medicine.

Remember, you don’t have to settle for “good enough” treatment. Read on to learn whether you should talk to your doctor about switching to a new medication.

8 Reasons to Switch Medications for Ulcerative Colitis

The decision to change medications can be driven by a number of factors, including a lack of symptom control, too many side effects, and steep financial costs. Here are some of the most common reasons people request a change of treatment:

1. The symptoms haven’t resolved.

Symptoms should start improving within the first couple of weeks of beginning a new treatment, says Jill Gaidos, MD, director of clinical research for the inflammatory bowel disease program at Yale University School of Medicine in New Haven, Connecticut. If not, your doctor might recommend upping the dose or adding a new medication to get the inflammation under control.

1. The symptoms haven’t resolved.

2. The symptoms improved at first but then returned.

Some people stop responding to treatment, prompting a switch, says Dr. Afzali. If you’re having a flare, tell your doctor right away.

2. The symptoms improved at first but then returned.

3. Blood or stool tests reveal that inflammatory markers aren’t improving.

Even if symptoms are subsiding, your doctor will check your blood and feces for inflammatory proteins at around the three-month mark, says Dr. Gaidos. If the markers aren’t back to normal or at least trending in the right direction, you might need a different medication.

3. Blood or stool tests reveal that inflammatory markers aren’t improving.

4. Tests show continued inflammation.

If you’re doing well about six months to a year after starting treatment, your doctor will check for endoscopic remission. They’ll use a colonoscopy or sigmoidoscopy test to check for signs of healing in your gut. If things don’t look normal, they might recommend a treatment change, even if your symptoms seem to be under control.

4. Tests show continued inflammation.

5. The side effects are bothersome.

Side effects don’t spur as many switches as disease-related reasons, but they still happen. If significant side effects cause problems with your daily functioning, your doctor may recommend a change, especially if there are better-tolerated options available, says Afzali.

5. The side effects are bothersome.

6. You’re having trouble sticking with the medication schedule.

Some people can’t remember to take a daily pill and prefer an infusion or injection instead, says Gaidos. Others dislike using a needle and decide to take the treatment in pill form.

6. You’re having trouble sticking with the medication schedule.

7. You can no longer afford the medication.

If you change insurance plans or your insurance company changes which medications they cover, you might find yourself facing a high price for treatment. That said, your doctor can help with prior authorizations, appeals, peer-to-peer reviews, patient assistance programs, and support from foundations, so speak up if that’s the case, says Afzali. “Changing medications should be a last resort if a therapy is clinically working well,” she says. There are also more generic versions of biologics called biosimilars available now.

7. You can no longer afford the medication.

8. You can’t do the things you want to do.

Everyone with UC has a treatment goal beyond numbers on lab tests. Some people want to eat a cheeseburger again or go shopping without always looking for a bathroom, says Gaidos. If the current treatment isn’t controlling your symptoms as well as it could, talk to your doctor about whether a new medication could help, especially if there are signs of ongoing inflammation.

8. You can’t do the things you want to do.

Assess the Ulcerative Colitis Treatment You’re Currently On

Answer these questions to evaluate whether you should ask your doctor about a new treatment plan.

Assess Your Ulcerative Colitis Treatment

Question 1/5

Since you began your current treatment, are symptoms continuing to interfere with your daily life?

  • A. Yes
  • B. No

Treatment Options for Ulcerative Colitis

Switching medications is common, but it requires careful consideration. “For somebody who’s young and is going to have this condition for the rest of their life, we really try and optimize the medications as much as possible before we switch therapies,” says Gaidos, adding that some medications might not work the second time you try them.

4 Treatment Options Your Doctor Might Recommend

  1. Adjust the dose. Sometimes, simply increasing the medication dose can bring symptoms under control.
  2. Shorten the dosing interval. Some biologic medications are administered every few weeks via intravenous infusions. The dosing intervals are sometimes flexible, based on patient needs. Ask your doctor whether you can get the next treatment sooner. 
  3. Add another medication. Some UC medications can be used alongside other ones to maximize the benefits. Your doctor might recommend staying on the current drug and adding another. 
  4. Change medications. In some cases, switching drugs is the best option.
  • Aminosalicylates These contain 5‐aminosalicylic acid, which works by blocking certain pathways in the body that cause gut inflammation. Often, they’re a first-line treatment for people with mild-to-moderate colitis, but in more severe cases, they can be paired with other drugs.
  • Corticosteroids If you’re not responding to 5-aminosalicylic acid, your doctor might recommend a short course of a corticosteroid to control flares. Because of their wide-ranging anti-inflammatory action and numerous side effects, though, corticosteroids aren’t recommended as a long-term treatment.

  • Immunomodulators These medications suppress the body’s immune system activity, decreasing inflammation. They can be given to people who haven’t responded to other treatments or alongside other medications (such as biologics) to make them more effective.
  • Biologics and Biosimilars Biologics are lab-made antibodies that stop certain proteins in the body from causing inflammation. Biosimilars are nearly identical copies of biologics, with similar effectiveness and safety profiles, that have been created to lower the costs of the treatment.
  • Janus Kinase Inhibitors These oral medications target part of the immune system that plays a role in triggering inflammation.

  • Diet Changes A healthy diet can’t cure UC, but it can go a long way toward managing symptoms when used with appropriate medications. Some foods — especially ones that are higher in fat, as well as red and processed meats — can play a big role in triggering symptoms. If you have nutrition deficiencies, your doctor may recommend vitamins and minerals in supplement form.

  • Surgery Your doctor may recommend a colectomy — removal of all or part of the colon — if multiple medications aren’t helping or symptoms are severe.

How to Talk to Your Doctor About Changing Treatments for Ulcerative Colitis

If you’re thinking about switching treatments, here are some things to discuss with your doctor.

11 Things to Tell Your Doctor

  1. What symptoms you’re experiencing 
  2. When symptoms last flared
  3. What signs of inflammation are evident on blood tests, stool tests, or imaging
  4. How the current medication works and how alternatives work differently
  5. The risks and benefits of each treatment you’re considering, plus alternatives
  6. What side effects are possible
  7. How quickly others feel better after switching to the medication
  8. Whether you prefer to take medication orally, as an injection, or by intravenous infusion
  9. Other inflammatory conditions you’re managing, such as psoriatic arthritis or rheumatoid arthritis
  10. Whether the new medication will be approved by your insurance
  11. How you’ll measure the success of the new treatment

4 Tips for Switching Ulcerative Colitis Treatments Successfully

Your doctor might recommend a new treatment if they think it will benefit you. Here’s how to set yourself up for success when switching:
It’s not uncommon for people with UC to switch to a new treatment within a few years. It’s not a failure on your part. Rather, finding the right medication for you, at the right time, takes some trial and error. The end result, including fewer symptoms and an improved quality of life, can be well worth it.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Barrett K et al. Using Corticosteroids Appropriately in Inflammatory Bowel Disease: A Guide for Primary Care. British Journal of General Practice. October 2018.
  2. Medication Options for Ulcerative Colitis. Crohn’s & Colitis Foundation.
  3. What Should I Eat With IBD? Crohn’s & Colitis Foundation.
  4. Rubin DT et al. ACG Clinical Guideline Update: Ulcerative Colitis in Adults. The American Journal of Gastroenterology. June 2025.
Additional Sources
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Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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Julie Stewart

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Julie Stewart is an author and editor with more than a decade of experience in health, science, and lifestyle writing. Her articles have appeared online for Men’s Health, Women’s Health, EatingWell, Vice, AARP The Magazine, and Shape.

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