Prednisolone (IBD / GI Use)

How it works

Prednisolone is a glucocorticoid that binds intracellular receptors to suppress pro-inflammatory gene transcription, reducing cytokine production and mucosal inflammation in the gut.

Prescribing in practice

• It is for short-term induction only and must not be stopped abruptly after more than a brief course; doses should be tapered to avoid adrenal insufficiency, and it is not a maintenance therapy for IBD.
• Prolonged or repeated courses risk osteoporosis, hyperglycaemia, hypertension, mood disturbance and increased infection susceptibility, so bone protection and steroid-sparing strategies should be considered.
• Provide a steroid treatment card and counsel on the risks of intercurrent illness and serious infections including chickenpox in non-immune patients.

Monitoring

Monitor blood glucose, blood pressure, weight and for signs of infection, with bone-health assessment when courses are prolonged or recurrent.

Counselling the patient

• Take with food in the morning and never stop suddenly after a longer course.
• Carry your steroid card and tell any healthcare professional you are taking steroids.
• Seek advice promptly if you feel unwell, develop an infection or are exposed to chickenpox or shingles.

Evidence & guidelines

Corticosteroids are an established option for inducing remission in active IBD, as set out in NICE ulcerative colitis and Crohn's disease guidance.