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Steroids for Crohn's Disease

Steroids for Crohn's Disease

What is Crohn’s disease?

It is a chronic inflammatory medical condition that affects the digestive tract. The common symptoms of this medical condition would be pain in the abdomen, diarrhea, loss of weight, and in rare cases, the presence of blood in the stool. The disease leads to the inflammation of the gastrointestinal tract lining. The inflammation caused by Crohn’s may involve different areas of the digestive tract in some people. The inflammation often spreads deep into the layers of the affected bowel tissues. The disease can be painful and sometimes lead to complications, which can be life-threatening. 

Currently, there is still no known cure for the disease. However, with the use of medications and therapies, one can effectively control the symptoms of the disease, and at the same time, lead a normal life along with the medical condition.

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Treatment

The treatment of this disease involves the use of medications, therapies, and in a few rare cases, surgery. There is no one common treatment that can be used for everyone. Doctors can opt for two types of treatment approach. The first one is the “top-up” approach, wherein the individual would be first given milder doses of the medication. The second approach is called the “top-down” approach, wherein the individual would be first started on stronger doses of medicines. The main goal of the treatment is to reduce the inflammation, which triggers the symptoms of the disease.

Steroids for Crohn’s Disease

Patients who are suffering from moderate to severe Crohn’s disease should be treated with the help of steroid drugs. The treatment should be carried on until the symptoms are improved for the better and the weight loss of the individual is reversed.

The doctor can also go in for immunomodulators such as azathioprine and mercaptopurine. However, it would take several months for the treatment to respond back positively. If the steroids do not work well for the individual, then the doctor can also opt for infliximab.

The oral form of steroids has been the support for treating moderate to severe forms of Crohn’s disease. The effectiveness of steroids in inducing remissions has been known for a long time. The treatment results are also seen very quickly instead of taking several months. The doctor would usually decide the dosage while keeping in mind various factors. However, taking 40 mg of prednisone on a daily basis for a period of 8-12 weeks has shown to achieve a lot of positive response. Steroids are known to ease inflammation because they have an effect to calm down an overactive immune system. The side effects of steroids are usually mild.

While you are under steroid medication, the doctor can also give you a calcium supplement or vitamin D supplement to protect your bones. Drugs such as risedronate and alendronate can help prevent the weakening of the bones. It would not be a good idea to frequently take steroids for a short duration because it can lead to side effects, which can get worse due to repeated dosages.

The Side Effects of Steroid Use

Some of the mild side effects of steroids are:

  • Weight gain
  • Stretch marks on the body
  • Acne on the face
  • Lack of sleep or insomnia
  • Growth of more facial hair
  • Sweating excessively at night
  • Changes in one's mood
  • Loss of memory 
  • Getting easily bruised, especially those who have thin skin
  • Hyperactivity

Some individuals with Crohn's disease may notice a couple of these side effects, while some would not notice any. The occurrence of the side effects would depend on the dosage of the steroids and for how long one is taking the medicine.

Below are the severe side effects of steroids that should not be ignored:

Since steroids are known to slow down the immune system, it makes it harder for the body to fight off any kind of infection. During the course of steroid treatment, one is more than likely to get any of the following types of infection:

Common Brands of Steroids

Below are the commonly prescribed steroids for Crohn’s disease:

Hydrocortisone

Hydrocortisone is a corticosteroid that works by reducing or preventing the tissues from responding back to inflammation. Hydrocortisone is also known to modify the body’s response to certain immune stimulations. Individuals who are allergic to hydrocortisone or any of its components, have a systemic fungal infection, or taking mifepristone should not use hydrocortisone. Before starting with hydrocortisone, make sure to inform the doctor if you have the following conditions:

  • Planning to get pregnant or are pregnant
  • If you are currently taking other types of medications, vitamins, and supplements whether they are prescribed or non-prescribed
  • Scheduled for any kind of immunization
  • Have a history of thyroid disorders
  • Kidney or liver damage
  • Diabetes
  • Stomach-related problems

There are certain medications that tend to interact with hydrocortisone. Thus, the doctor would need to know if you are using any of the following medications:

  • Methotrexate or ritodrine - these drugs can interact with hydrocortisone and increase their actions along with other side effects.
  • Aprepitant - can lead to an increased risk of experiencing hydrocortisone side effects.
  • Aspirin or anticoagulants - the actions and side effects of aspirin or anticoagulants can be increased with the intake of hydrocortisone.
  • Barbiturates, hydantoins, or rifampin - the effectiveness of hydrocortisone tends to decrease with the intake of these drugs.

Hydrocortisone can be taken as directed by the doctor or one can also check the label of the medicine for further instructions. It can be orally taken with or without food. If you happen to develop an upset stomach, then it is better to take the medicine after meals to reduce stomach irritation. Avoid abruptly stopping your hydrocortisone intake since it can increase your risk of developing side effects.

Check with the doctor on how to gradually stop taking hydrocortisone. The common side effects of hydrocortisone are:

The severe side effects of this medicine include:

  • Severe allergic reactions such as breathing difficulties
  • Chest pain
  • Swelling of the mouth
  • Pain in the eye
  • Changes in one's mood leading to depression
  • Pain and weakness in the muscles
  • Unexplained weight gain or loss
  • Sudden fever or chills

Hydrocortisone is known to cause a rise in blood sugar levels. Hence, diabetic patients should regularly monitor their blood sugar level. Taking hydrocortisone can also lead to an increase in blood pressure and water retention. Hence, check with the doctor if there is a need to change your dietary intake, especially when it comes to the reduction of salt in your diet.

Prednisone

Prednisone is a corticosteroid that prevents the release of substances in the body that are known to cause inflammation. However, prednisone also suppresses the immune system. This drug is mostly used as an anti-inflammatory agent or an immunosuppressant to treat various types of medical conditions such as breathing disorders, lupus, and certain skin conditions.

Those who have fungal infections should not be taking prednisone. Steroid medications can lead to the weakening of the immune system, thereby making it easier for opportunistic microorganisms to attack the body. You should also avoid being near to anyone who's sick or be in crowded places.

Check with the doctor if you experience the following symptoms:

  • Blood in the stool
  • Severe form of depression
  • Changes in your personality or behavior
  • Irregular breathing or shortness of breath
  • Extensive pain in the upper stomach
  • Vision-related problems

If you are allergic to prednisone, then do not take this medicine. To ensure this medicine is safe for you, you should inform the doctor if you have the following conditions:

  • Any illness that can lead to diarrhea
  • Problems related to the kidney or liver
  • Thyroid disorders
  • Tuberculosis
  • Glaucoma
  • Stomach ulcers 
  • A past history of malaria
  • Diabetes
  • Any kind of mental illness
  • High blood pressure
  • Heart problems

Prednisone is known to cause low birth weights or defects to unborn babies if a pregnant woman is taking this medicine during the first trimester. For this reason, it is very important for women to inform their doctor if they are planning to get pregnant or are pregnant before taking prednisone. Mothers who breastfeed must inform the doctor before taking prednisone since the drug can pass into breast milk. 

Prednisone should be taken exactly as prescribed by the doctor or follow the directions mentioned on the medicine label. Moreover, prednisone should be taken with food. Do not crush, chew, or break the tablet. You should swallow it as a whole. While on prednisone treatment, make sure to also monitor your blood pressure level. The side effects of prednisone include:

  • Blurry vision
  • Pain in the eye
  • Rapid weight gain
  • Nausea and vomiting
  • Depression
  • Mental changes
  • Increased heart rate
  • Hallucinations
  • High blood pressure
  • Acne
  • Slow healing of wounds
  • Excessive sweating
  • Insomnia

An overdose of prednisone is not expected to cause any type of life-threatening manifestations, but if steroids are used for a longer duration, then it can lead to certain symptoms such as skin thinning, easy bruising, changes in body shape or location where fat is deposited, increased facial hair and acne, as well as menstrual problems in women.

Budesonide

Budesonide can help reduce the inflammation in the body due to certain conditions. Budesonide is known to treat mild cases of Crohn’s disease. If you are allergic to budesonide, then inform the doctor before taking it. Before taking budesonide, you need to tell your doctor if you have the following conditions:

  • Tuberculosis
  • Viral or fungal infection
  • Liver problems
  • Stomach ulcers
  • Eczema
  • Certain allergies
  • A weak immune system
  • Hypertension (high blood pressure)
  • A family history of diabetes
  • Glaucoma

Also inform the doctor if you are pregnant or planning to get pregnant. Budesonide can easily pass into the breast milk and may harm the baby. Budesonide should not be given to anyone who is younger than 18 years old. Moreover, the drug should be taken exactly as prescribed by the doctor or follow the instructions mentioned on the medicine label. Do not increase or decrease the dosage level without your doctor's advice. This medicine should be taken in the morning with a full glass of water. Swallow budesonide as a whole. Do not crush or chew the tablet or capsule. The dose of budesonide are as follows:

  • Adults: The initial dose would be 9 mg orally once a day in the morning to be taken for a period of eight weeks.
  • For children: The enteric coated capsule should be taken at 6 mg orally once a day in the morning for a period of three months.

The side effects of budesonide include:

  • Swelling of the ankles
  • Pain and burning sensations while urinating
  • Feeling tired or fatigued
  • Bruising easily
  • Menstrual problems among women
  • Nausea
  • Vomiting
  • Dizziness
  • Lightheadedness
  • Stretch marks

Other common side effects are:

Most patients suffering from Crohn’s disease and on steroid medications are usually under treatment for a few weeks or months. The doctor can then gradually adjust the dosage based on the improvement of the symptoms or how fast the body is responding to the steroid treatment.

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