page85
Rectal preparations
Predenema
c
(Chemidex) A
Retention enema
,
prednisolone 20 mg (as sodium
metasulphobenzoate) in 100-mL single-dose dispo-
sable pack. Net price 1 (standard tube) = 71p, 1 (long
tube) = £1.21
Dose
ulcerative colitis, by rectum,
ADULT and CHILD over 12
years, initially 20 mg at bedtime for 2–4 weeks, continued if good
response
Predfoam
c
(Forest) A
Foam
in aerosol pack,
prednisolone 20 mg (as meta-
sulphobenzoate sodium)/metered application,
net
price 14-application canister with disposable appli-
cators = £6.32
Excipients
include cetostearyl alcohol,
disodium edetate, polysorbate
20,
sorbic acid
Dose
proctitis and distal ulcerative colitis, 1 metered application
(20 mg prednisolone) inserted into the rectum once or twice daily
for 2 weeks, continued for further 2 weeks if good response; CHILD
not recommended
Predsol
c
(UCB Pharma) A
Retention enema
,
prednisolone 20 mg (as sodium
phosphate) in 100-mL single-dose disposable packs
fitted with a nozzle.
Net price 7 = £6.00
Dose
rectal
and rectosigmoidal ulcerative colitis and Crohn’s
disease,
by rectum,
initially 20 mg at bedtime for 2–4 weeks,
continued if good response;
CHILD not recommended
Suppositories
,
prednisolone 5 mg (as sodium phos-
phate).
Net price 10 = £1.35
Dose
ADULT and CHILD proctitis and rectal
complications of
Crohn’s disease, by rectum, 5 mg inserted night and morning after
a bowel movement
1.5.3
Drugs affecting the
immune response
For the role of
azathioprine,
ciclosporin,
mercapto-
purine, and methotrexate in the treatment of inflamm-
atory bowel disease,
see p.
59.
Folic acid (section 9.1.2) should be given to reduce the
possibility of
methotrexate toxicity [unlicensed indica-
tion].
Folic acid is usually given at a dose of 5 mg once
weekly on a different
day to the methotrexate;
alter-
native regimens may be used in some settings.
AZATHIOPRINE
Indications
see under Inflammatory Bowel Disease,
p.
59;
autoimmune conditions and prophylaxis of
transplant rejection (section 8.2.1);
rheumatoid arth-
ritis (section 10.1.3);
severe refractory eczema (sec-
tion 13.5.3)
Cautions
section 8.2.1
Contra-indications
section 8.2.1
Hepatic impairment
section 8.2.1
Renal impairment
section 8.2.1
Pregnancy
section 8.2.1
Breast-feeding
section 8.2.1
Side-effects
section 8.2.1
Dose
. Severe acute Crohn’s disease,
maintenance of remis-
sion of Crohn’s disease or ulcerative colitis [unli-
censed indications],
ADULT
over 18 years,
by mouth,
2–2.5 mg/kg daily; some patients may respond to
lower doses
Preparations
Section 8.2.1
CICLOSPORIN
(Cyclosporin)
Indications
severe acute ulcerative colitis refractory
to corticosteroid treatment [unlicensed indication];
transplantation and graft-versus-host disease,
nephrotic syndrome (section 8.2.2);
rheumatoid arth-
ritis (section 10.1.3);
atopic dermatitis and psoriasis
(section 13.5.3)
Cautions
section 8.2.2
Hepatic impairment
section 8.2.2
Renal impairment
section 8.2.2
Pregnancy
see Immunosuppresant therapy,
p.
553
Breast-feeding
section 8.2.2
Side-effects
section 8.2.2
Dose
. By continuous intravenous infusion,
ADULT
over 18
years, 2 mg/kg daily over 24 hours;
dose adjusted
according to blood-ciclosporin concentration and
response
Preparations
Section 8.2.2
MERCAPTOPURINE
(6-Mercaptopurine)
Indications
see under Inflammatory Bowel disease,
p.
59;
acute leukaemias and chronic myeloid leuk-
aemia (section 8.1.3)
Cautions
section 8.1.3
Hepatic impairment
section 8.1.3
Renal impairment
section 8.1.3
Pregnancy
section 8.1.3
Breast-feeding
section 8.1.3
Side-effects
section 8.1.3
Dose
. Severe acute Crohn’s disease,
maintenance of remis-
sion of Crohn’s disease or ulcerative colitis [unli-
censed indications],
ADULT
over 18 years, by mouth, 1–
1.5 mg/kg daily; some patients may respond to lower
doses
Preparations
Section 8.1.3
METHOTREXATE
Indications
see under Inflammatory Bowel Disease,
p.
59;
malignant disease (section 8.1.3);
rheumatoid
arthritis (section 10.1.3); psoriasis (section 13.5.3)
Cautions
section 10.1.3
Contra-indications
section 10.1.3
Hepatic impairment
section 10.1.3
Renal impairment
section 10.1.3
Pregnancy
section 10.1.3
Breast-feeding
section 10.1.3
Side-effects
section 10.1.3
BNF 61
1.5.3 Drugs affecting the immune response
65
1
Gastro-intestinal system