- Foam enema 10% (£9.33 = 14 application canister)
- Hydrocortisone foam enema should be considered as the first line steroid rectal foam
- Budenofalk® capsules containing e/c granules 3mg (£75.05 = 100 capsules)
- Budenofalk® 2mg/dose rectal foam (£57.11 = 14 application canister)
- 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
- Consider Budenofalk® rectal foam as a second line alternative to hydrocortisone foam enema
- 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). The policy indicates that in exceptional circumstances the Trust-Managed Individual Patient Treatments process can be used for this indication.
Corticosteroids in Inflammatory Bowel Disease (IBD)
- 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.
- Avoid ultra-short or low doses. For the majority of patients start at prednisolone 40mg and decrease over 8 weeks.
- Steroids have no role in maintenance therapy.
- 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
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1.5 Chronic bowel disorders >
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