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Steroid Therapy
Prednisolone or Budesonide
Patient Information Sheet

If your inflammatory bowel disease (Crohn’s or Ulcerative colitis) is “flaring up” your
doctor may decide to prescribe steroid therapy in the form of either prednisolone or
budesonide.
What are steroids?
Steroids are natural substances produced by the adrenal gland. They are used for many
reasons including reducing inflammation.
How do steroids work?
Large doses of steroids dampen the body’s immune system and so reduce inflammation.
They are very effective in treating flare ups of inflammatory bowel disease in short
courses of 6-8 weeks. There is no evidence that they improve disease control if taken
long term.

How and when do I take the tablets?
Steroid tablets can be taken altogether, with food (e.g. at breakfast time).
What are the potential side effects?
Short term: increased appetite, weight gain, acne, high blood sugars, high blood
pressure, fluid retention, puffy face, facial hair growth, difficulty in sleeping, mood swings,
and a reduced ability to fight infections.
Long term: osteoporosis (thinning of the bones), thinning of the skin, increased risk of
bruising, muscle weakness, cataracts, diabetes, dependency on steroids.
How do I avoid side effects?
Over 80% of Budesonide is removed on first pass through the liver, leaving less than 20%
uptake into the systemic circulation. This means that the medication predominantly works
local y on the bowel lining, with less systemic side-effects. In some patients it is possible
to give steroids directly onto the lining of the bowel (as in suppositories, foam or liquid
enemas).
Can I have immunisations whilst on steroids?
Immunisation with “live” vaccines should be avoided but “inactive”
vaccines are safe (such as the flu vaccine).
Steroid Patient Info Gastro Team Reviewed June 2012
Can I drink alcohol whilst on steroids?
Yes, in moderation as per national guidelines.
Do I continue to take my usual medication?
Yes, if there is any doubt please ask your IBD nurse or Doctor.
Prednisolone can affect your warfarin control.

Do steroids affect fertility or pregnancy?
Steroids do not affect fertility and can be safely taken in pregnancy. We try to avoid them
in the last trimester, but if they are needed it is important to inform your obstetrician and
gastroenterologist.

Where can I obtain further information about steroids?
If you have any questions about steroids please ask your doctor, IBD nurse specialist or
pharmacist.
What dose of Prednisolone should I take? Do not stop taking steroid tablets suddenly.
They must be reduced slowly, ot herwise you may suffer withdrawal
problems.
Steroid Patient Info Gastro Team Reviewed June 2012
All patients taking steroids by mouth must carry the steroid card given to you by the
pharmacy. If you have a flare up of your Crohn’s or Ulcerative Colitis when you are
reducing your steroid tablets then please phone the helpline on: 01582 718368
Additional Information

Budesonide Vs Prednisolone – Budesonide is most commonly used for Microscopic
Colitis and smal bowel and right sided Crohn’s disease. The data to support its use in UC
is less convincing. As it predominantly works topical y, with little (5-20%) systemic uptake,
there are less side effects.
Weight gain – You may gain weight as a result of taking steroids, this is often most
noticeable in the face and is known as a “Cushingoid” appearance. Even if this is quite
evident, your appearance wil return back to normal as the dose is reduced over a period
of 2-3 months
Blood Sugar - Whilst you are taking steroids, the way in which your body normal y
manages sugar may be affected. It is important to get this checked by your GP during
treatment as occasional y these levels need to be treated with medicines eg. Gliclazide
Blood pressure – Very occasional y people on steroids may get an increase in their
blood pressure. It is important that your blood pressure should be checked when you
come to the outpatient clinic (ask the nurse who is weighing and measuring you, as she
may not know you are on treatment). Between visits to the outpatient clinic, it is a good
idea if you have your local general practice check your blood pressure weekly.
Vaccinations / Immunisations - The new European Crohn’s and Colitis Guidelines
suggest al IBD patients should undergo an immunity screen and if necessary,
appropriate vaccinations. Vaccinations given during and up to 3 months after a steroid
course may not prove effective. Live vaccinations should be avoided.
Infection – Whilst taking steroids the body suffers a mild suppression of its immune
system increasing the risks of developing opportunistic infections. . is mildly immune
suppressed. Some people taking steroids are at slightly increased risk of infection. This
is not usual y a major concern, however, if there has been any contact with chicken pox
you need to let us know
Other il nesses – If you become unwel and have been on steroids in the previous nine
months it is important that you inform the doctors involved in your care, as they may need
to restart low dose steroid treatment for the during of that il ness.
Stopping treatment – Make absolutely sure that you do not run out of your steroid
tablets. It is dangerous to stop suddenly, and you might become seriously il . The slow
reduction that we plan is safe.
Keep all medicines out of the reach of children. Never give any medication
prescribed for you to anyone else. It may harm them even if their symptoms are the
same as yours.
Steroid Patient Info Gastro Team Reviewed June 2012

Source: http://www.drmattwjohnson.com/wp-content/uploads/Steroids.pdf