1.5.2 Corticosteroids

Steroids are the most appropriate treatment for acute disease but do not prevent relapse.

The link with peptic ulceration and standard formulation of prednisolone is weak and therefore enteric coated and soluble tablets offer no additional benefit.

Systemic corticosteroids see section 6.3 Corticosteroids.

Beclometasone dipropionate
  • Clipper® M/R tablets 5mg (£52.79)

Indications

  • Adjunct to aminosalicylates in acute mild to moderate ulcerative colitis

Dose

  • 5mg in the morning; maximum duration of treatment 4 weeks

Notes

  1. For initiation by a Consultant Gastroenterologist only
Budesonide
  • Budenofalk® capsules containing e/c granules 3mg (£63.04 = 3x3mg daily)
  • Entocort® CR capsules containing e/c m/r granules 3mg (£83.16 = 9mg once daily)

Indications

  1. Budenofalk® and Entocort® CR is licensed for the induction of remission in patients with mild to moderate Crohn's disease affecting the ileum and/or ascending colon for up to 8 weeks. In theory it has steroid sparing benefits in patients requiring frequent courses, but this has not been demonstrated in clinical trials.

Dose

  • Budenofalk® three capsules once daily or one capsule three times daily, for up to 8 weeks; reduce dose for the last 2 weeks of treatment
  • Entocort® CR 9mg once daily in the morning for up to 8 weeks; reduce dose for the last 2–4 weeks of treatment

Notes

  1. The two preparations of budesonide are not interchangeable and should be prescribed by brand, not generically.
Hydrocortisone
  • Foam enema 10% (£9.33 = 14-application canister)

Indications

  • Ulcerative colitis, proctitis, proctosigmoiditis

Dose

  • Foam: initially 1 metered application (125mg hydrocortisone acetate) once or twice daily for 2–3 weeks, then once on alternate days
  • Solution: twice daily dose via rectal administration, in combination with IV hydrocortisone for in-patient management of acute colitis.

Notes

  1. Hydrocortisone enema is appropriate initial treatment for relapse, but if the symptoms have not resolved within two weeks specialist advice should be sought.
  2. Colifoam® enema is useful for patients who cannot tolerate the liquid prednisolone enema.
Prednisolone
  • Retention enema 20mg in 100ml (£7.50 = 7 enemas)
  • Suppositories 5mg (£27.49 = 10 suppositories)

Indications

  • Ulcerative colitis, and Crohn's disease

Dose

  • By rectum - enema: initially 20mg at bedtime for 2–4 weeks, continued if good response
  • By rectum – suppositories: 5mg inserted night and morning after a bowel movement

Notes

  1. Oral corticosteroid dosages and durations advised by consultant gastroenterologists in South Devon Healthcare Foundation Trust for the management of active colitis are:Severe disease (More than 6 bloody stools per 24 hours, systemic symptoms e.g. pyrexia, tachycardia,) requires in-patient treatment with intravenous steroids
  2. Moderate disease (4-6 bloody stools per 24 hours) or step-down from intravenous treatment: Prednisolone 40mg daily for 1 week, then 30mg daily for 1 week, then 20mg daily for 1 month then review by a gastroenterologist
  3. Mild disease (less than 4 bloody stools per 24 hours): Prednisolone 20mg daily for four weeks and then review
Budesonide prolonged release (Cortiment®)

Not routinely commissioned for use in NEW Devon CCG and South Devon and Torbay CCG, following consideration by the clinical policy committee. Click here for more information. The policy indicates that in exceptional circumstances the Trust-Managed Individual Patient Treatments process can be used.

 

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