Prednisone is a corticosteroid that doctors prescribe for some people with ulcerative colitis. The use of the medicine has significantly improved outcomes for people with ulcerative colitis. However, it can cause severe side effects, so doctors usually only advise using it during disease flares.

Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD). It causes the lining of the colon to become inflamed and develop sores known as ulcers. Prednisone is a form of corticosteroid that doctors have used for many years to treat UC.

Corticosteroids have helped drop the mortality rate of UC from about 61% to within 4–7%. However, the potential severity of this medication’s side effects makes it less desirable for the long-term management of UC.

Despite some drawbacks, prednisone and other corticosteroids can play an important role in the treatment of UC symptoms during flares.

Prednisone is one of several corticosteroid medications that people can take orally or by inhalation or injection. Corticosteroids decrease the body’s immune system response, so they help reduce acute inflammation in the body.

A doctor may prescribe prednisone as an effective short-term treatment for a variety of conditions, including:

  • UC
  • certain types of arthritis
  • asthma
  • allergic reactions
  • lupus
  • multiple sclerosis

Prednisone can have a positive and fast effect on acute UC symptoms. The drug’s powerful anti-inflammatory properties mean that it can help control stomach pain, diarrhea, and bloody stools, among other symptoms.

Prednisone usually works within 1–4 days if a person takes the appropriate dosage. However, some people may experience symptom relief within just a few hours of taking it.

Doctors usually recommend taking prednisone during disease flares, which are periods in which symptoms return or worsen.

Research has shown that prednisone is not effective in maintaining UC remission. Due to this, experts recommend against its use during periods when UC symptoms are not present.

They also recommend against doctors prescribing corticosteroids preemptively so that patients can self-medicate during a flare. Instead, a doctor should prescribe prednisone on an as-needed basis.

Corticosteroids are highly likely to cause side effects.

As prednisone strongly suppresses the immune system, it slows the body’s response to infection or injury. By impairing the immune response in this way, the drug can lead to significant and potentially severe side effects.

The possible side effects of prednisone include:

  • fatigue
  • slow healing, for example, of bruises and cuts
  • headaches
  • mood changes
  • appetite changes
  • weight gain
  • acne
  • dizziness
  • swelling in the arms, face, legs, hands, or feet
  • increased risk of infection
  • increased blood sugar levels, which can be especially problematic for people with diabetes

Consistent, long-term use of prednisone can lead to other health issues. The potential complications of the drug include:

  • increased risk of infection
  • ulcers or gastrointestinal bleeding
  • bone loss and increased risk of fractures
  • osteoporosis
  • atherosclerosis, or stiffening of the arteries
  • adrenal suppression
  • cataracts
  • high blood pressure
  • steroid withdrawal syndrome, which causes symptoms such as fatigue, joint pain, fever, and muscle pain
  • insomnia
  • thinning hair and skin

Prednisone can negatively interact with other vitamins, medications, or herbs.

A person should always tell their doctor about any other medications that they are taking before starting prednisone. A few common medications that can interact with prednisone include:

  • blood thinners
  • certain antibiotics
  • diabetes medication
  • diuretics
  • estrogen
  • nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen

A person should make their doctor aware of all their diagnosed health conditions before using prednisone. Prednisone can worsen certain conditions, including diabetes and high blood pressure.

A person should also let their doctor know if they may be pregnant, are trying to become pregnant, or have a history of allergic reactions to corticosteroids.

Although prednisone or other steroids may work well for short periods to suppress symptoms, they are not a viable long-term solution. For the maintenance of UC, doctors often recommend other medications and lifestyle changes.

A doctor may prescribe one or more of the following medications, which people take over the long term to help prevent UC flares and progression:

  • Aminosalicylates: These drugs decrease inflammation in the intestinal lining, and doctors typically use them to treat mild-to-moderate UC. Examples include:
    • balsalazide
    • mesalamine
    • olsalazine
    • sulfasalazine
  • Immunomodulators: These can be helpful when neither aminosalicylates nor prednisone can control symptoms or when a doctor wants to make other medications, such as biologics, more effective. Examples include:
    • azathioprine
    • cyclosporine
    • tacrolimus
    • 6-mercaptopurine
  • Janus kinase (JAK) inhibitors: These oral medications, which include tofacitinib, block a specific enzyme responsible for inflammation. They can be effective in treating moderate-to-severe UC.
  • Biologics: These medications comprise natural materials that block certain proteins from causing inflammation. Doctors reserve their use for moderate-to-severe cases of UC. Examples include:
    • adalimumab
    • golimumab
    • infliximab
    • ustekinumab
    • vedolizumab

Certain foods may trigger UC symptoms. If this is the case, dietary changes can help a person manage UC. For example, they may wish to avoid spicy or high fiber foods.

If medications and dietary changes do not help, a doctor may recommend a colectomy. This surgical procedure removes the large bowel, which comprises the colon and rectum, and replaces it with an external or internal pouch.

An external pouch empties digestive waste into a bag that attaches to the outside of the abdomen. A surgeon will create an internal pouch inside the body from the small bowel and attach it to the anus, keeping the anal sphincter muscles intact.

A person should consult their doctor if they are experiencing a flare of new or worse UC symptoms. They should never take leftover prednisone without first talking with their doctor.

A doctor can provide detailed instructions on when and how to take the medication. They can also monitor how it affects UC symptoms and check for side effects.

Prednisone is only suitable for short-term use, and taking it for too long increases a person’s risk of complications, including withdrawal.

A doctor may prescribe prednisone for the temporary relief of UC symptoms during a flare. Due to its potential to cause severe side effects, interactions, and complications, treatment with prednisone typically only lasts for a short period.

A doctor will likely prescribe other long-term medications and dietary changes to minimize UC flares. A person should only take medications as their doctor has directed.