Prednisone
Methylprednisolone
Budesonide
Hydrocortisone
NOT for maintenance therapy => work very quickly to suppress acute flare-ups
Only during the beginning of remission
Must taper, of course! Think about the renal steroids!
Must taper, of course! Think about the renal steroids!
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). Source: http://www.webmd.com/ibd-crohns-disease/crohns-disease/corticosteroids-for-inflammatory-bowel-disease
SYSTEMIC CORTICOSTEROIDS
For the past 30 years, corticosteroids have been the mainstay of therapy in patients with moderate to severe active inflammatory bowel disease.25 Initial treatment is prednisone, 40 to 60 mg per day. In severely ill hospitalized patients, reasonable initial therapy is hydrocortisone, 100 mg administered intravenously every eight hours. Intravenous therapy generally produces rapid improvement of symptoms, with maximal benefit occurring when the corticosteroid has been administered for six to eight days.
Once improvement has occurred, prednisone is tapered by 5 to 10 mg per week until the dosage is 15 to 20 mg per day. This dosage is then tapered by 2.5 to 5 mg per week until the drug is discontinued. Confusion over the taper schedule can be avoided if patients are given written instructions and 5-mg tablets are used. The goal is to get patients off corticosteroids within a relatively short time but still maintain disease remission. Concomitant use of 5-ASA agents can be helpful. Alternatively, long-term alternate-day corticosteroid therapy can be used in patients with refractory Crohn's disease, although it may be necessary to use dosages of 20 to 25 mg every other day.26Systemic corticosteroids have an extensive side effect profile. Acute effects include acne and severe mood changes, which are particularly common in young patients. Adrenal insufficiency can be triggered by an intercurrent infection in patients who are receiving low doses or in patients who have just been tapered off of corticosteroids. Visual changes can occur because of steroid-induced hyperglycemia. Early cataract formation is another possible problem. Aseptic joint necrosis, the most dreaded side effect, usually occurs in patients receiving long-term, high-dose corticosteroid therapy. The incidence of this complication is 4.3 percent.27Source: http://www.aafp.org/afp/1998/0101/p57.html
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