If you live with ulcerative colitis (UC), your doctor may recommend treatment with biologic medication.
These medicines are effective for controlling symptoms and helping you achieve remission, but they can also cause side effects. Knowing what they are is important in order to manage them.
Reactions From the Needle Stick
If your biologic is subcutaneous, meaning you apply it with a small needle under the skin, you might experience the following side effects where the needle went in:
- Redness
- Mild pain
- Itching
- Tenderness
- Slight swelling
These reactions usually last from a few hours to a couple of days. They are very common and, in most cases, there is no reason to worry.
How to treat these reactions:
- Apply a cold compress or ice pack before and after the shot.
- Check with your doctor to see if you can take pain medication to ease discomfort.
- Change the spot where the needle goes in for each dose.
Reactions During or After an Infusion
If you are given the biologic intravenously (by IV) at an infusion center, you may experience:
- Headaches
- Low blood pressure or dizziness
- Nausea
How to treat headaches:
- Stay hydrated.
- Rest in a quiet, dark place.
- Apply cold or hot compresses to your head or neck.
- Massage your head.
- Drink caffeine, preferably in the morning.
- Talk to your doctor about which pain medications are safe for you.
How to treat nausea or dizziness:
- Avoid heavy meals during the first 24 hours after the dose.
- Eat easy-to-digest foods, like gelatin.
- Rest and avoid sudden movements that can worsen nausea.
- Drink lemonade, ginger ale, peppermint tea, and plenty of water.
- Avoid strong smells and other nausea triggers.
Fatigue
It's common for biologics for UC to cause general tiredness, especially in the first weeks while your body adjusts to the treatment.
How to treat fatigue:
- Get a blood test to see if you need iron or other vitamins.
- Stay active with gentle activities like walking, meditating, or practicing yoga.
- Avoid caffeine and screens in the evenings to improve sleep.
- Limit alcohol.
- Choose light, nutrient-rich meals.
Mild infections
Because biologics lower immune system activity, they increase the likelihood of viral, bacterial, fungal, or parasitic infections, such as:
- Colds
- Sinusitis
- Urinary tract infections
- Respiratory tract infections
The most common symptoms of an infection include:
- Digestive symptoms, such as diarrhea, nausea, or vomiting
- Fever
- Headache
- Neck stiffness
- Chills or excessive sweating
- Sore throat
- Painful urination
- Muscle aches
- Nasal discharge or congestion
If you have any of these symptoms, talk to your doctor to figure out if you have an infection, what type of infection it is, and what medication you can take.
When to Call Your Doctor
Call your doctor if you have symptoms of infection, such as:
- Persistent fever or a fever higher than 100.4 F
- Difficulty breathing
- Severe swelling of the face, lips, or throat
- Chest pain
- Widespread hives
- Severe or bloody diarrhea
- Persistent vomiting
- Clear signs of infection, such as severe pain when urinating, cough with thick phlegm, or worsening skin sores
- Confusion, severe dizziness, or fainting
- Yellowing of the skin or eyes (jaundice)
These symptoms require immediate medical attention.
Can You Use Biologics if You Had Cancer?
The latest evidence shows that if you've had cancer, you can use these medicines safely with careful management.
If you currently live with cancer, check with your doctor to figure out if biologics are suitable for your immune system.
Get Ready for Biologic Treatment
You can take steps before starting treatment to limit side effects, especially fatigue and infections.
Get a complete health panel
Your medical team may request:
- Blood tests
- Tuberculosis tests
- Hepatitis screening
- A review of your vaccines
Keep a calendar
Include:
- Shot or infusion dates
- Medical appointment reminders
- Space to record symptoms
This helps you stay organized and gives your doctor a clear view of the progress of your treatment.
Prepare a kit you can bring to your biologic treatment
It can include:
- Alcohol wipes
- Cold compresses
- A notebook to record symptoms
- Water, books, magazines, or other items to entertain yourself during infusions
How Your Medical Team Can Help
Your medical team is your main ally. They can help you with the following:
Education and training:
- Teach you how to use the autoinjector
- Explain what to expect after each dose
- Answer your questions about side effects
Medication adjustments:
If you have persistent side effects, your medical team can:
- Adjust the dose
- Change the treatment frequency
- Switch you to another biologic, if necessary
Continuous monitoring:
- Run blood tests
- Monitor for signs of infection
- Check your progress and response to treatment
Emotional support:
- Provide support from specialized nurses, especially during your first treatments
Questions to Ask Before Your First Dose
Preparing questions ahead of time can help you feel more confident. Here are some suggestions:
- What are the most common side effects of this biologic?
- Can I take pain medication to ease side effects?
- What signs require medical attention?
- How long do the side effects last?
- What should I avoid (medications, foods, activities)?
- How should I store the medication at home?
- Can I get vaccines while I'm receiving treatment?
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Gastro Center of Maryland: “What is a biologic?”
Global Autoimmune Institute: “Biologics for Autoimmune Disease: What You Should Know.”
Johns Hopkins Arthritis Center: “Side Effects of Biologic Medications.”
National Centre for Immunisation and Research Surveillance: “Injection site reactions.”
Willis Knighton Health: “Biological Therapy/Immunotherapy (Side Effects).”
BioDrugs: “Recurring Fatigue After Biologic Administration: Patient-Reported Data from the Dutch Biologic Monitor.”
Crohn's and Colitis Foundation: “Managing Fatigue with IBD."
Epidemiology: “Risk of common infections in people with inflammatory bowel disease in primary care: a population-based cohort study.”
Cleveland Clinic: “Infectious Diseases,” “Nausea.”
CDC: “Know the Signs and Symptoms of Infection.”
Gut: “Risks and benefits of biologic therapy for inflammatory bowel diseases.”
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University of Chicago Medicine: “Biologics and Inflammatory Bowel Disease (IBD).”
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BiologicMeds.org: “The Truth About Biologics: Myths vs. Facts.”
Cancers: “Management of Patients with IBD and History of Cancer.”
Gastroenterology and Hepatology: “Preparing for Biologic or Immunosuppressant Therapy.”
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