Prednisone is a corticosteroid that doctors prescribe for some people with ulcerative colitis (UC). It has significantly improved outcomes for those with UC, but it can cause severe side effects. Doctors usually only recommend using it during flares.
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. Doctors
Prednisone and other corticosteroids can be important in treating UC symptoms during flares.
However, prednisone can have severe adverse effects and is unsuitable as a long-term treatment for UC.
Here, learn how doctors use prednisone to manage UC symptoms.
Prednisone is one of several corticosteroid medications that people can take orally or by inhalation or injection. Corticosteroids reduce the body’s immune response and help lower acute inflammation in the body.
This can make it useful for treating UC, where inflammation in the gut can cause severe symptoms.
Prednisone can have a positive effect on acute — referring to severe and sudden — UC symptoms. Its anti-inflammatory properties mean it can help control abdominal pain, diarrhea, and bloody stools, among other symptoms.
According to The Arthritis Society, 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. How quickly it works depends on how a person takes it and whether the drug’s formulation allows for immediate or delayed release.
Doctors usually recommend taking prednisone during disease flares, which are periods when symptoms return or worsen. The medication
However, research suggests it is ineffective in maintaining UC remission. As a result, experts recommend against using it when there are no symptoms.
They also advise against prescribing corticosteroids preemptively, which would allow people to self-medicate during flares. Instead, doctors should prescribe prednisone as necessary when symptoms occur.
Corticosteroids can have severe side effects.
As prednisone suppresses the immune system, it slows the body’s response to infection or injury. By impairing the immune response in this way, it can have significant and potentially severe side effects.
The possible side effects of prednisone and other corticosteroids
- slow healing, for example, of bruises and cuts
- mood changes
- appetite changes
- weight gain
- 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 can
- increased risk of infection
- ulcers or gastrointestinal bleeding
- bone loss and increased risk of fractures
- atherosclerosis, or stiffening of the arteries
- adrenal suppression
- high blood pressure
- steroid withdrawal syndrome, which causes symptoms such as fatigue, joint pain, fever, and muscle pain
- thinning hair and skin
Prednisone can negatively interact with other medications, vitamins, and herbs.
A person should always tell their doctor about any other treatments that they are taking before starting prednisone.
According to a 2018 review, some common medications that can interact with prednisone include:
- blood thinners
- certain antibiotics
- diabetes medication
- beta 2 agonists, which can treat chronic obstructive pulmonary disease and bronchial asthma
- nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve)
Additionally, taking prednisone may reduce the effectiveness of vaccines.
A person needs to make their doctor aware of all health issues before using prednisone. This drug can worsen certain conditions, including diabetes and high blood pressure.
People also need to let a doctor know if they may be pregnant, are trying to become pregnant, or have a history of allergic reactions to corticosteroids.
Prednisone and other corticosteroids may work well for short periods to suppress symptoms, but they are not a viable long-term solution. For the maintenance of UC, doctors
A doctor may prescribe one or more of the following medications, which people take in 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:
- Immunomodulators: These can be helpful when neither aminosalicylates nor prednisone can control symptoms. They can also benefit when a doctor wants to make other medications, such as biologics, more effective. Examples can include:
- Janus kinase, or JAK, inhibitors: These oral medications, which include tofacitinib (Xeljanz) and upadacitinib (Rinvoq), block a specific enzyme responsible for inflammation. They can effectively treat moderate to severe UC if biologics do not work well.
- Biologics: These medications contain natural materials that block certain proteins from causing inflammation. Doctors reserve their use for moderate to severe cases of UC. Examples can include:
As the Crohn’s and Colitis Foundation points out, certain foods may trigger UC symptoms. If this is the case, dietary changes can help a person manage the condition. For example, an individual may wish to avoid spicy or high fiber foods.
If medications and dietary changes do not help, a doctor may recommend a colectomy. This procedure involves removing the large bowel, which comprises the colon and rectum, and replacing 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 creates an internal pouch inside the body from the small bowel and attaches it to the anus, keeping the anal sphincter muscles intact.
A person needs to consult a doctor if they experience any new or worsened UC symptoms. They also need to avoid taking leftover prednisone without speaking with a healthcare professional first.
A doctor can provide detailed instructions about when and how to take prednisone. They can also monitor how it affects UC symptoms and check for side effects.
Prednisone is only suitable for short-term use — taking it for too long increases the risk of complications, including severe
Here are answers to common questions about prednisone for ulcerative colitis.
How long does it take for prednisone to work on ulcerative colitis?
The Arthritis Society notes that prednisone usually works within 1–4 days, but some people feel better within a few hours.
How much prednisone should I take for ulcerative colitis?
For people with ulcerative colitis, doctors often prescribe a starting dose of
Can prednisone put ulcerative colitis in remission?
As part of a wider treatment plan, prednisone
What is the best medication for ulcerative colitis?
The treatment plan will depend on the individual and how severe their symptoms are.
A doctor will often start by prescribing aminosalicylates, such as mesalazine. They may also combine these with:
- steroids, such as prednisone
- immunomodulators, such as tacrolimus
- biologics, such as infliximab
- JAK inhibitors, such as tofacitinib.
As a person’s condition changes, the doctor will likely review their medications.
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, a course of prednisone treatment is typically short.
Doctors tend to recommend other medications and dietary changes to minimize UC flares in the long term. A person should only take medications as their doctor has directed.