page84
1.5.2
Corticosteroids
For the role of corticosteroids in acute ulcerative colitis
and Crohn’s disease,
see Inflammatory Bowel
Disease,
p.
59.
BECLOMETASONE DIPROPIONATE
Indications
adjunct to aminosalicylates in acute mild
to moderate ulcerative colitis;
asthma (section 3.2);
allergic and vasomotor rhinitis (section 12.2.1);
oral
ulceration [unlicensed indication] (section 12.3.1)
Cautions
section 6.3.2;
interactions: Appendix 1
(corticosteroids)
Contra-indications
section 6.3.2
Hepatic impairment
manufacturer advises avoid in
severe impairment—no information available
Pregnancy
section 6.3.2
Breast-feeding
section 6.3.2
Side-effects
section 6.3.2;
also nausea,
constipation,
headache,
and drowsiness
Dose
. 5 mg in the morning;
max.
duration of treatment 4
weeks;
CHILD
safety and efficacy not established
Clipper
c
(Chiesi) A
Tablets
,
m/r,
ivory,
beclometasone dipropionate
5 mg,
net price 30-tab pack = £56.56.
Label:
25
BUDESONIDE
Indications
see preparations
Cautions
section 6.3.2;
for autoimmune hepatitis,
monitor liver function tests every 2 weeks for 1
month,
then at least every 3 months;
interactions:
Appendix 1 (corticosteroids)
Contra-indications
section 6.3.2
Hepatic impairment
section 6.3.2
Pregnancy
section 6.3.2
Breast-feeding
section 6.3.2
Side-effects
section 6.3.2
Dose
. See preparations
Budenofalk
c
(Dr Falk) A
Capsules
,
pink,
enclosing e/c granules,
budesonide
3 mg,
net price 100-cap pack = £75.05.
Label:
5,
10,
steroid card,
22, 25
Dose
mild to moderate Crohn’s disease affecting ileum or
ascending colon,
chronic diarrhoea due to collagenous colitis,
ADULT over 18 years, 3 mg 3 times daily for up to 8 weeks; reduce
dose for the last 2 weeks of treatment (see also section 6.3.2);
CHILD 12–18 years see
BNF for Children
Autoimmune hepatitis,
ADULT over 18 years,
induction of remis-
sion,
3 mg 3 times daily; maintenance, 3 mg twice daily
Rectal foam
,
budesonide 2 mg/metered application,
net price 14-application canister with disposable
applicators and plastic bags = £57.11
Excipients
include cetyl alcohol,
disodium edetate, propylene glycol,
sorbic acid
Dose
ulcerative colitis affecting sigmoid colon and rectum,
by
rectum,
ADULT over 18 years,
1 metered application (budesonide
2 mg) once daily for up to 8 weeks
Entocort
c
(AstraZeneca) A
CR Capsules
, grey/pink, enclosing e/c, m/r granules,
budesonide 3 mg,
net price 100-cap pack = £99.00.
Label:
5,
10,
steroid card,
25
Note
Dispense in original container (contains desiccant)
Dose
mild to moderate Crohn’s disease affecting the ileum or
ascending colon,
9 mg once daily in the morning for up to 8
weeks;
reduce dose for the last 2–4 weeks of treatment (see also
section 6.3.2);
CHILD 12–18 years see
BNF for Children
Enema
,
budesonide 2 mg/100 mL when dispersible
tablet reconstituted in isotonic saline vehicle,
net
price pack of 7 dispersible tablets and bottles of
vehicle = £33.00
Dose
ulcerative colitis involving rectal
and recto-sigmoid dis-
ease,
by rectum,
1 enema at bedtime for 4 weeks;
CHILD 12–18
years see
BNF for Children
HYDROCORTISONE
Indications
ulcerative colitis,
proctitis,
proctosigmoi-
ditis
Cautions
section 6.3.2;
systemic absorption may
occur;
prolonged use should be avoided
Contra-indications
intestinal obstruction,
bowel per-
foration, recent intestinal anastomoses,
extensive fis-
tulas;
untreated infection
Side-effects
section 6.3.2;
also local irritation
Dose
. By rectum see preparations
Colifoam
c
(Meda) A
Foam
in aerosol pack,
hydrocortisone acetate 10%,
net price 14-application canister with applicator =
£9.28
Excipients
include cetyl alcohol,
hydroxybenzoates (parabens),
propy-
lene glycol
Dose
initially 1 metered application (125 mg hydrocortisone
acetate) inserted into the rectum once or twice daily for 2–3
weeks, then once on alternate days;
CHILD 2–18 years see
BNF for
Children
PREDNISOLONE
Indications
ulcerative colitis,
and Crohn’s disease;
other indications,
see section 6.3.2,
see also prepara-
tions
Cautions
section 6.3.2;
systemic absorption may
occur with rectal preparations; prolonged use should
be avoided
Contra-indications
section 6.3.2;
intestinal obstruc-
tion, bowel perforation, recent intestinal anastomoses,
extensive fistulas;
untreated infection
Hepatic impairment
section 6.3.2
Renal impairment
section 6.3.2
Pregnancy
section 6.3.2
Breast-feeding
section 6.3.2
Side-effects
section 6.3.2
Dose
. By mouth,
initially 20–40 mg daily (up to 60 mg daily
in some cases),
preferably taken in the morning after
breakfast;
continued until remission occurs, followed
by reducing doses
. By rectum,
see preparations
Oral preparations
Section 6.3.2
64
1.5.2 Corticosteroids
BNF 61
1
Gastro-intestinal system