Steroids (Corticosteroids)

Corticosteroids are hormones produced by the adrenal glands. They have many important functions in the body, including control of inflammatory responses. The corticosteroid medications are artificial versions of these natural hormones.

Corticosteroid is usually shortened to just steroid. That shortening leads to some confusion, because the muscle-building anabolic steroids used by athletes and body builders are also called steroids.

The steroid medications used to treat IBD include prednisone, methylprednisolone, hydrocortisone, and budesonide. With the exception of a few formulations, they are available as generics, so you don’t need to be prescribed a brand-name medication that could be more expensive.

How do steroids work?

Steroid medications are anti-inflammatory and work by suppressing the immune system. In general, steroids are helpful with flares of IBD but shouldn’t be taken for long periods because of their harsh side effects.

Steroids are not helpful in preventing future flares. In some cases, using steroids for a long period of time might actually worsen Crohn’s disease, leading to abscesses and fistulas.

How is it administered?

Most steroid medications for IBD come in pill form and are administered orally but they can also be administered rectally, as an enema.
Infusion into a vein is a third possibility.

Late-release Oral Steroids

Budesonide is an oral steroid medication that can be formulated so it travels through the gastrointestinal tract without getting released until reaches the colon. This late release means that the drug can be targeted at the inflammation in the colon.

One formulation of budesonide (Entocort) is released at the end of the ileum and in the right, or ascending, part of the colon, which is the first part of the organ. Entocort is now available as a generic so you don’t need to be prescribed the brand-name drug.

Budesonide also comes in encapsulated so it is delivered farther along in the colon, in middle and left, or descending, segments. This formualtion, sold as the brand-name product Uceris, is often prescribed for ulcerative colitis patients whose inflammation affects those parts of the colon.

Enemas

The products used for steroid enemas are usually formulated as liquids, because of this it is recommended that the enema be administered before bed and you lay down.

The foam products, which come in aersol cans, can help with this problem. They are lighter and retained better. But they don’t reach as far into the colon as the liquid enemas, so if your disease is higher up in the colon, the foam products may not be a good choice.

 One product, Proctofoam, includes a steroid, hydrocortisone, and a topic anesthetic, pramoxine. Another product, Cortiform, has hydrocortisone as the only active ingredient.

When will I feel better?

Some people experience relief of symptoms within two or three days. It may take a week to feel the maximum benefit.

The maximum benefit from Entocort capsules and hydrocortisone enemas may take slightly longer. If steroid medication isn’t making you feel better, you should call your care team.

Side effects

Steroid medications have many side effects, but they usually occur after long-term use. You should let your care team know if you have fever or any other signs of infection, nausea, euphoria, mood swings, or psychosis. Some of the side effects include:

  • Striae (stretch marks)
  • Acne
  • Hirsutism (hair growth)
  • Glucose intolerance (diabetes like condition)
  • Osteoporosis
  • High blood pressure
  • Masking of infections or intestinal perforation
  • Peptic ulcers
  • Edema
  • Cushingoid appearance (moonface and buffalo hump)
  • Mood disturbances.
  • Sleep disturbances.
  • Weight gain.
  • Increased risk for infection

Possible drug interactions

Many different kinds of drugs interact with steroids. Let a member of your care team know if you take any of the following medications:

  • oral contraceptives
  • digoxin
  • estrogen replacement
  • cyclosporine
  • methotrexate

How long do I need to take steroids?

Although steroids may temporarily make you feel better, they do not aid heal of the lining of the intestines. They are not a long-term solution to IBD. You should be on them for as short a time as possible. For some people that will be a few weeks. For others, it may be a few months.

About one in every four IBD patients who need to be treated with steroid medications become dependent on them. They can’t stop taking them without experiencing a flare. Immune modulators or biologics can help patients dependent on steroids taper off of them.

It is important to not stop your steroid regimen abruptly. Gradually reducing the amount of steroid medication you are taking will prevent a serious side effect known as acute adrenal crisis, caused by lack of cortisol, a hormone produced by the adrenal glands. Taking steroid medications reduces the output of cortisol from your adrenal glands. Your adrenal glands need time to ramp up and start producing cortisol again once you stop taking steroids.

Symptoms of acute adrenal crisis include weakness, sweating, abdominal pain, nausea and vomiting, and sometimes loss of consciousness.
Your care team will discuss how to gradually taper your dose over many days to avoid acute adrenal crisis.

Corticosteroids and Pregnancy

Women planning to become pregnant should discuss their treatment options with their care team. Some animal studies have shown that prednisone might harm a fetus, although the data are conflicting. Prednisone is only recommended for use during pregnancy when the benefit clearly outweighs the risk.