Ulcerative Colitis Medications - Steroids

Steroids are the bodies natural mechanism for suppressing inflammation. They are used in much higher doses than the body naturally produces - and are mainly used to treat flare-ups. They may also occasionally be used as a maintenance drug. They have the advantage that they are fast acting - and will start to reduce inflammation as soon as they are used. The disadvantage with steroids is that have guaranteed side effects - especially if they are used for prolonged periods. The most noticeable of these is water retention and a "puffy face". Other effects can include a loss of drive and osteoporosis. Steroids for colitis now come with three possible delivery methods oral, enema and controlled release enteric oral.

Oral Steroids

Oral steroids usually come in the form of prednisolone tablets. They are absorbed into the blood stream - so act indiscriminately throughout the whole of the body. This makes them only really suitable for short term use during flare-ups. This allows the colitis to be managed whilst other drug therapies such as mesalazine and azathioprine have time to become effective. Oral steroids are usually taken for between 4 and 8 weeks - with the dose being slowly reduced after the 4-8 week period. This reduction process is called "Steroid Taper" and allows the body to begin making its own steroids again.
One slight consideration is that oral steroids come in three varieties - enteric coated, non-coated and water soluble. The feedback from a number of people is that the water soluble prednisolone actually appear to work better for Colitis

Controlled Release Oral Steroids

There is currently one controlled release steroid - Entocort. Although designed to treat Chron's disease it can be used to treat colitis with reduced side effects. The drug is released in the terminal ileum and ascending colon (The first part of the colon in the direction of travel.). This means that more of the drug is localized to the colon - whilst a significant amount is absorbed into the bloodstream.

Steroid Enemas

Most modern steroid enemas are foam based - as the likelihood of someone with colitis being able to retain a water based enema is quite low. These act topically applying the steroid directly to the colon - with only small amounts being absorbed into the bloodstream. This makes side effects less likely. The downside is that they can only reach the descending colon and rectum - so for those with extensive colitis oral steroids may be needed. A combination of Entocort and steroid enemas can provide topical treatment to the majority of the colon - again minimizing side effects. As the two main steroid enemas differ quite greatly I will cover them separately.

Colifoam Enemas

Colifoam enemas are a low volume foam enema - applied by filling an applicator and then inserting this into the rectum. The foam only really reaches the rectum so best suited to the treatment of proctitis. Being a low volume enema it is significantly easier to retain than predfoam.

Predfoam Enemas

Predfoam enemas are a much higher volume foam enema - inserted directly into the rectum via a disposable tube. The larger volume reaches higher into the colon - making it well suited to the treatment of left sided colitis (descending colon). The main drawback is that the higher volume makes the enema harder to retain.

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