1.5.2 Corticosteroids

Hydrocortisone
  • Foam enema 10% (£9.33 = 14 application canister)

Notes

  1. Hydrocortisone foam enema should be considered as the first line steroid rectal foam
Budesonide
  • Budenofalk® capsules containing e/c granules 3mg (£75.05 = 100 capsules)
  • Budenofalk® 2mg/dose rectal foam (£57.11 = 14 application canister)

Indications

  • Capsules are included for induction of remission in mild or moderate ileocaecal Crohn's disease. Treat for up to 8 weeks - reduce dose in last two weeks of treatment
  • Rectal foam is included for Ulcerative colitis

Notes

  1. Consider Budenofalk® rectal foam as a second line alternative to hydrocortisone foam enema
Prednisolone
  • Retention enema 20mg in 100ml (£7.50 = 7 enemas)
  • Suppositories 5mg (£55.47 = 10 suppositories)
Budesonide prolonged release (Cortiment®)

The routine commissioning of budesonide 9mg prolonged release multi-matrix tablets used for up to 8 weeks treatment is not accepted in Devon for induction of remission in adults with mild to moderate active ulcerative colitis where 5-aminosalicylic acid (5-ASA) treatment is not sufficient (see Commissioning Policy for more details)

Corticosteroids in Inflammatory Bowel Disease (IBD)

  1. Before starting steroids consider carefully if symptoms are due to active disease or other diagnosis e.g. co-existing irritable bowel syndrome. A raised CRP may help to confirm active disease.
  2. Avoid ultra-short or low doses. For the majority of patients start at prednisolone 40mg and decrease over 8 weeks.
  3. Steroids have no role in maintenance therapy.
  4. At one year, approximately 50% of patients with ulcerative colitis will be steroid dependent or steroid refractory.

Decision to start immunomodulator therapy for patients with ulcerative colitis will be made by gastroenterologist, typically if:

  • More than 1 course of steroids in any 2 year period
  • Following any severe attack requiring IV steroids

 

Home > Formulary > Chapters > 1. Gastrointestinal > 1.5 Chronic bowel disorders > 1.5.2 Corticosteroids

 

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