1.5.2 Corticosteroids inflammatory bowel disease

Choice of budesonide preparation will depend on where in the GI tract the drug is released / licensed indications. Therefore products should be prescribed by brand
ChoiceDrugDosage
1st choicePrednisolone tabletsDose: initially 40mg daily, preferably taken in the morning after breakfast for 1 week, reducing by 5mg every week till stopped. Total course 8 weeks duration
Or
Budesonide
Choice of budesonide preparation will depend on where in the GI tract the drug is released / licensed indications. Therefore products should be prescribed by brand
Budesonide 3mg capsules enclosing e/c granules (Budenofalk®)

Dose: mild to moderate Crohn’s disease affecting ileum and / or ascending colon, 9mg once daily in the morning for up to 8 weeks

Budesonide 3mg capsules enclosing e/c m/r granules (Entocort®)Dose: mild to moderate Crohn’s disease affecting ileum and / or ascending colon, 9mg once daily in the morning for up to 8 weeks
Budesonide 9mg m/r tablet (Cortiment®)Dose: mild to moderate ulcerative colitis, 9mg once daily in the morning for up to 8 weeks

Prescribing Notes

  • Refractory or moderate inflammatory bowel disease usually requires adjunctive use of an oral corticosteroid for 8 weeks.
  • Ensure that risk of osteoporosis and fragility fractures is managed appropriately.
  •  Calcium and vitamin D supplementation should be recommended for patients taking oral steroids.
  • Patients should be risk assessed and considered for a bisphosphonate. NICE considers current or recent use of high dose oral or high dose systemic glucocorticoids (more than 7.5mg prednisolone or equivalent per day for 3 months or longer) to be a major risk factor for fracture, see NICE CG146.
  • Patients with inflammatory bowel disease may have increased gastric transit times and resulting difficulty with absorption. Standard release prednisolone rather than enteric coated prednisolone is preferred in these patients.
  • Modified-release budesonide is associated with fewer adverse effects in patients with Crohn’s disease than prednisolone. However, it appears to be significantly less effective at inducing remission in patients with severe disease and with more extensive colonic involvement.
  • Steroid enemas should be reserved for those patients who do not respond to mesalazine. Please note prednisolone foam enemas are very high cost. Predsol retention enema 20mg/100ml rectal solution is a cost effective option. If a steroid foam is required Budenofalk® (budesonide) rectal foam is less expensive than prednisolone foam.