gastrointestinal disorders
Medications for Inflammatory Bowel Disease
Corticosteroids
Corticosteroids, beginning at high doses, are useful for acute flare-ups of most forms of IBD when 5-ASA compounds are inadequate. However, corticosteroids are not appropriate for maintenance. IVhydrocortisoneormethylprednisoloneis used for severe disease;oralprednisoneorprednisolonemay be used for moderate to severe disease. Treatment is continued until symptoms remit (usually 7 to 28 days) and then tapered weekly to 20 mg once a day. Treatment is then further tapered by 2.5 to 5 mg weekly depending on clinical response, while instituting maintenance therapy with 5-ASA or immunomodulators. Adverse effects of short-term corticosteroids in high doses include hyperglycemia, hypertension, insomnia, hyperactivity, and acute psychotic episodes. Hydrocortisoneenemas or foammay be used for proctitis and left-sided colon disease; an enema solution is given once a day or twice a day. The enema should be retained in the bowel as long as possible; instillation at night, with the patient lying on the left side with hips elevated, may prolong retention and extend distribution. Treatment, if effective, should be continued daily for about 2 to 4 weeks, then every other day for 1 to 2 weeks, and then gradually discontinued over 1 to 2 weeks. Budesonideis a corticosteroid with a high (>90%) first-pass liver metabolism; thus, oral administration may have a significant effect on gastrointestinal tract disease but minimal adrenal suppression. Oralbudesonidehas fewer adverse effects thanprednisolonebut is not as rapidly effective and is typically used for less severe disease.Budesonidemay be effective in maintaining remission for 8 weeks but has not yet proved effective for long-term maintenance. The drug is available for small-bowel Crohn disease, and an enteric-coated, delayed-release form is available for ulcerative colitis. It is also available outside the United States as an enema. 400 to 800 units/day and calcium 1200 mg/day. Corticosteroids should be used with caution in patients with chronic liver disease including Cirrhosis because bioavailability and clinical effects may be enhanced. 