In the medical field, steroids are prescribed by doctors to treat a variety of illnesses.
There are three ways corticosteroids may be administered:
Oral corticosteroids enter directly into the bloodstream, targeting the entire body rather than specific areas in the body. As such, they are generally prescribed short-term, to ease symptoms during flare-ups.
Oral corticosteroids are generally prescribed in the form of prednisone tablets, although other corticosteroids may come in pill form as well. A patient will generally be limited to a four- to eight-week period on corticosteroids, at which point the physician will usually put the patient on a “steroid taper” to gradually reduce dosage so the body resume producing its own steroids.
For patients taking corticosteroids orally, a calcium supplement will often be prescribed to help ease the risks of osteoporosis that come with long-term use of oral corticosteroids.
Controlled-release corticosteroids are taken orally, as well, but the medicine is directed to the patient’s ileum and ascending colon. This targets the treatment to a specific area to maximize effects. There is currently only one controlled-release corticosteroids available, Entocort, and as discussed in the budesonide section below, this medication can be costly.
Steroid enemas can be particularly effective because, as expected, they deliver treatment directly to the affected area.
Usually foam-based, corticosteroid enemas direct treatment to the colon, with very little of the drug seeping into the bloodstream. However, corticosteroid enemas only go as far as the descending colon and rectum. For more severe cases of Crohn’s, these enemas may be supplemented with oral corticosteroids.
A patient may choose between colifoam enemas—a foam in low concentration that doesn’t reach quite as far as predfoam enemas. While this can reduce its? effectiveness, it also makes it easier for the body to retain. Predfoam enemas are inserted into the colon via a tube. This allows the foam to reach all the way to the upper colon, thus improving its effectiveness. Unlike the colifoam enema, the predfoam enema is higher in volume, which makes it harder to retain.
Corticosteroids also come in several different forms. Some of the most often prescribed forms of corticosteroids are:
Prednisone is most often taken orally, although it also may be administered via a shot. Unfortunately, Prednisone can elevate blood glucose levels, so it’s important to get your blood checked regularly while taking prednisone. ?Other side effects include water retention, insomnia, and mania, especially in patients with bipolar disorder.
Also used to reduce inflammation, prednisolone is prescribed for everything from lupus to arthritis. In liquid form, prednisolone is prescribed as Pediapred Oral Liquid Medrol. It is also prescribed under the brand name Prednisolone, as well as Orapred. Some people have had allergic reactions to Prednisolone, so it might be wise to start slowly. Prednisolone can also weaken your immune system, making you susceptible to infection.
Hydrocortisone is a glucocorticoid, which is produced by the adrenal gland.
Normally released by the body in response to stress, hydrocortisone suppresses the immune system, making it valuable for Crohn’s patients. Hydrocortisone is often administered through IV to patients suffering from severe Crohn’s symptoms. Hydrocortisone may also be administered through enema.
The possible side effects of hydrocortisone include depression, weight gain, bloody stools, and an elevation in blood pressure, among others. If you suffer side effects from this medication, your doctor can alter your dosage to a more manageable level.
Used for hay fever and other allergy problems, budesonide is marketed as ?Rhinocort nasal spray and Pulmicort oral inhalant. It is also sold as Entocort, Symbicort, and Entocort EC. In the United States, Entocort can cost $800 to $1,500, it may not be an option for those whose insurance doesn’t fully cover its cost. However, generic forms of Entocort are available.
Budesonide works by reducing inflammation in the digestive tract and, because it has been linked to a reduction in the loss of bone density in patients, it can be a better alternative to other treatments.
Budesonide is usually used for mild to moderate cases of Crohn’s, but it may also be used for patients who have gone into remission in order to manage their symptoms. Some of the more severe side effects include difficulty breathing, facial swelling, white patches in the throat, mouth, or nose, or any behavioral changes. The latter is rare and usually applies to children.
While each corticosteroid has its own group of side effects, corticosteroids can be very beneficial in the management of symptoms related to Crohn’s disease. Speak with your physician about available corticosteroids and which might be most helpful to you.