Corticosteroids for inflammatory bowel disease

Examples

Generic Name	Brand Name
betamethasone	Celestone
budesonide	Entocort EC
dexamethasone
hydrocortisone acetate (intrarectal foam)	Proctofoam HC
hydrocortisone (oral)	Cortef
hydrocortisone (retention enema)	Cortenema
methylprednisolone
prednisolone	Orapred
prednisone
triamcinolone	Kenalog, Triacet

Some of these medicines may be taken as pills. If the disease affects only the lower part of the colon, corticosteroids can be given by enema. For disease that only affects the rectum, suppositories and topical creams can be used. In severe cases, some corticosteroids are given through a needle in a vein (IV).

How It Works

These medicines reduce inflammation.

Why It Is Used

Corticosteroids are used to treat ulcerative colitis and Crohn's disease (inflammatory bowel disease, or IBD).

Ulcerative colitis

• Corticosteroid pills are used to stop symptoms of moderate to severe ulcerative colitis when aminosalicylates, such as sulfasalazine or mesalamine, have not worked.
• Corticosteroid enemas, suppositories, creams, or foam can be used to treat mild to moderate ulcerative colitis that is limited to the rectum or lower part of the colon.
• Severe extensive disease sometimes requires treatment with intravenous (IV) corticosteroids.

Crohn's disease

Oral or intravenous (IV) corticosteroids can be used to treat:

• Mild to moderate Crohn's disease. Budesonide (Entocort EC), a corticosteroid you take as a pill, affects only the intestinal tract. Because of this, it may cause fewer side effects than other corticosteroids. Budesonide doesn't work as well for Crohn's disease as other corticosteroids. But it has worked to put mild to moderate disease in remission (a period without symptoms). It is not used long-term.
• Moderate to severe disease. The corticosteroids prednisone and prednisolone lead to disease remission in 60% to 70% of people.¹
• Severe disease. For severe disease, you will most likely get corticosteroids (like hydrocortisone) through a vein (intravenous or IV). This is usually done in the hospital.

How Well It Works

Corticosteroids improve or stop the symptoms of ulcerative colitis and Crohn's disease. These medicines are used to put the disease in remission (a period without symptoms). They are not used long-term.

Corticosteroids do not keep ulcerative colitis or Crohn's disease in remission for the long term. When the disease has gone into remission, your doctor will gradually reduce the strength and the amount of corticosteroid you are taking.

Only people who do not get better with other medicines—less than half of people with IBD—need to take corticosteroids. Of these people, many go into remission after taking corticosteroids.² Some people with IBD may need to keep taking a small dose of corticosteroids to help keep them in remission.

Steroid enemas may be especially helpful for inflammation in the lower colon and the rectum.

Side Effects

Some common side effects of corticosteroids include:

• Increased risk of infection.
• High blood pressure (hypertension).

Other side effects may appear after you take this medicine for a long time. These include:

• Weight gain.
• Acne.
• Mood swings.
• Psychosis.
• Increased facial hair.
• Osteoporosis.
• Cataracts.
• Higher blood sugar level.
• Bone damage without infection (aseptic necrosis).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Long-term use of corticosteroids is discouraged because of the high risk of long-lasting side effects. Symptoms of inflammatory bowel disease may come back after a person stops taking corticosteroids. Your doctor may have you take an aminosalicylate (such as sulfasalazine or mesalamine) or an immunomodulator (such as azathioprine or 6-mercaptopurine) at the same time you are taking corticosteroids. These medicines will help keep your symptoms from coming back when you stop taking the corticosteroid.

People who take corticosteroids for more than 2 to 3 months should take calcium and vitamin D supplements or other medicines, such as bisphosphonates, to prevent osteoporosis. For more information, see the Medications section of the topic Osteoporosis. Your doctor may want you to have a bone density test to check for osteoporosis.

Short-term use of corticosteroids by children generally is considered safe. Long-term use carries the risk not only of a delay in growth but also of the side effects that occur in adults. But the negative effects of severe IBD on a child's growth and development are worse than the possible side effects of steroids, if the child needs steroids to control the disease. Corticosteroids are safe during pregnancy to treat a flare-up of symptoms.

Newer steroids in enema form may be useful for longer-term management of IBD because the enema form causes fewer side effects that affect the whole body.

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Author:	Monica Rhodes	Last Updated: October 9, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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