Ulcerative Colitis Medications - Steroids
Steroids are the bodies natural mechanism for suppressing inflammation.
They are used in much higher doses than the body naturally produces
- and are mainly used to treat flare-ups. They may also occasionally
be used as a maintenance drug. They have the advantage that they
are fast acting - and will start to reduce inflammation as soon
as they are used. The disadvantage with steroids is that have guaranteed
side effects - especially if they are used for prolonged periods.
The most noticeable of these is water retention and a "puffy
face". Other effects can include a loss of drive and osteoporosis.
Steroids for colitis now come with three possible delivery methods
oral, enema and controlled release enteric oral.
Oral steroids usually come in the form of prednisolone tablets.
They are absorbed into the blood stream - so act indiscriminately
throughout the whole of the body. This makes them only really suitable
for short term use during flare-ups. This allows the colitis to
be managed whilst other drug therapies such as mesalazine and azathioprine
have time to become effective. Oral steroids are usually taken for
between 4 and 8 weeks - with the dose being slowly reduced after
the 4-8 week period. This reduction process is called "Steroid
Taper" and allows the body to begin making its own steroids
One slight consideration is that oral steroids come in three varieties - enteric coated, non-coated and water soluble. The
feedback from a number of people is that the water soluble prednisolone actually appear to work better for Colitis.
Download our Oral Steroid Taper information sheet
Latest Advice: In order to prevent osteoporosis it is now advised that calcium supplements are taken when using oral steroids. Please see the supplements page or if you are on free prescriptions you should be able to obtain these through your GP.
Controlled Release Oral Steroids
There is currently one controlled release steroid - Entocort. Although
designed to treat Chron's disease it can be used to treat colitis
with reduced side effects. The drug is released in the terminal
ileum and ascending colon (The first part of the colon in the direction
of travel.). This means that more of the drug is localized to the
colon - whilst a significant amount is absorbed into the bloodstream.
Most modern steroid enemas are foam based - as the likelihood of
someone with colitis being able to retain a water based enema is
quite low. These act topically applying the steroid directly to
the colon - with only small amounts being absorbed into the bloodstream.
This makes side effects less likely. The downside is that they can
only reach the descending colon and rectum - so for those with extensive
colitis oral steroids may be needed. A combination of Entocort and
steroid enemas can provide topical treatment to the majority of
the colon - again minimizing side effects. As the two main steroid
enemas differ quite greatly I will cover them separately.
Colifoam enemas are a low volume foam enema - applied by filling
an applicator and then inserting this into the rectum. The foam
only really reaches the rectum so best suited to the treatment of
proctitis. Being a low volume enema it is significantly easier to
retain than predfoam.
Predfoam enemas are a much higher volume foam enema - inserted
directly into the rectum via a disposable tube. The larger volume
reaches higher into the colon - making it well suited to the treatment
of left sided colitis (descending colon). The main drawback is that
the higher volume makes the enema harder to retain.
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