Treating inflammatory bowel disease Oral steroids Information for patients Gastroenterology
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What is my medicine? Steroids are anti-inflammatory drugs used in the treatment of moderate to severe inflammatory bowel disease (IBD). They provide a rapid relief of symptoms in acute flare-ups, of both Crohn s disease and ulcerative colitis, in most patients. The steroids most commonly used in the treatment of IBD are prednisolone, hydrocortisone, busesonide (Entocort) or Belometasone Dipropionate (Clipper). Steroids can be given in tablet form, intravenously (straight into a vein) or as an enema or suppository inserted into the anus. How do the steroids work? Steroids work by reducing inflammation in the bowel. This allows the damaged bowel to heal. The dose has to be large enough to be effective, so normally you would start on a high dose. Steroids must be reduced gradually to lessen the chance of inflammation returning. How and when should I take the tablets? Prednisolone is usually prescribed as tablets and it is important that you take the tablets together in one dose with food. You might find that while you are taking steroids you experience symptoms of heartburn. If this happens, your GP may consider prescribing something to relieve this. Steroids can disrupt sleep patterns, it is therefore advisable that you take them in the morning to minimise this. How long will I take the steroids for? You will be on the course of steroids for approximately 2 to 3 months. It is dangerous to suddenly stop steroids, and you should follow the reducing regime, indicated by your doctor or nurse specialist. The dose should only be altered on advice from your specialist. page 3 of 8
Can I take other medications? Steroids can react with other medications. It is therefore important that you inform the doctor or specialist nurse of all the medications that you are taking. Aspirin, and anti-inflammatory drugs such as ibuprofen, should not be taken whilst you are on steroids, as they increase the risk of a stomach ulcer. Indigestion remedies and ulcer healing drugs should not be taken at the same time of day as steroids, as they may interfere with the absorption. Ensure that you inform your doctor or pharmacist that you are on steroids before commencing any new tablets or medicines. You should be given a steroid card when you collect your prescription from pharmacy. It is important to carry this with you until you finish your course of steroids. Will I need to have any tests? Before starting treatment, your doctor or specialist nurse may perform blood tests to help determine the severity of the inflammation. If you have not had chicken pox, the doctor may take a blood test to check if you are immune to this. Whilst taking steroids, you are more prone to infections, and chicken pox can be serious if contracted whilst on high dose steroid treatment. If you have not had chicken pox, or are not sure whether you have had it, please tell the doctor or specialist nurse before starting the steroids. Patients taking long-term steroids are more at risk from osteoporosis (fragile bones). You should be prescribed a calcium supplement with your course of steroids. Your doctor may also advise that you have a bone density scan (DEXA) to monitor the condition of your bones. page 4 of 8
What side effects are there? Steroids have a number of potential side effects. When you collect your prescription the pharmacist will give you a drug leaflet. It is important that you read this carefully before taking the tablets. Side effects are dose dependent. This means that as the dose of the steroids is reduced, the risk of side effects should also be reduced. The most common side effects that you may experience are as follows: Increased risk of infection Indigestion Thrush of the mouth Headaches Reddened skin Round face Increase in appetite Weight gain Acne Sleep disturbances Mood changes such as a feeling of euphoria or tearfulness Abdominal distension (swollen stomach) Irregular periods Increased hair growth particularly on the face Thinning of the skin/bruising Side effects relating to long term use of steroids include: Osteoporosis - can increase your risk of fracture Glaucoma - an increase of pressure in the eye High blood pressure Diabetes Long term skin fragility page 5 of 8
Are there any other treatment options? There may be other treatment options but this will depend upon which part of your bowel is inflamed, and how severe the inflammation is. Please ask your doctor or specialist nurse if you have any queries. Who should I contact if I have any concerns? If you would like more information about steroids or have any concerns about your treatment, please talk to your doctor or nurse specialist. The Inflammatory Bowel Disease nurse specialists can be contacted on: Royal Hallamshire Hospital 0114 271 2209 The Medicines Advice Line 0114 271 3401 (2.00pm - 5.00pm, Monday to Friday) Northern General Hospital 0114 226 9031 The Medicines Advice Line 0114 271 4371 (2.00pm - 5.00pm, Monday to Friday) page 6 of 8
Helpful information Crohn s and Colitis UK Information service 0845 130 2233 www.crohnsandcolitis.org.uk National Osteoporosis Society 0845 450 0230 (9.00am - 5.00pm, Monday to Friday) www.nos.org.uk page 7 of 8
Prepared by: Dr Alan Lobo, Dr Kumar Basu, Kerry Robinson, Alison Wright, Bev Fieldsend, Joanna Armitage Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more www.sheffieldhospitalscharity.org.uk Registered Charity No 1059043 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD5244-PIL1705 v4 Issue Date: June 2016. Review Date: June 2018