Steroids in GI (Prednisolone, Budesonide, Methylprednisolone)

Corticosteroids

Systemic: prednisone, prednisolone, methylprednisolone (Solu-Medrol IV).

Topical/local-acting: budesonide (Entocort, Cortiment, Budenofalk) — released in the gut with limited systemic absorption; dexamethasone for some uses.

Steroids broadly suppress the immune system and reduce inflammation. They are extraordinarily effective at calming acute inflammation but have many side effects with long-term use because they suppress many normal body functions.

**Prednisone or prednisolone for IBD flare**: typical course 40 mg daily, taper by 5 mg per week, total course 6-8 weeks. Take in the morning with food.

**Budesonide (Entocort, Cortiment) 9 mg daily** for 8 weeks, then taper. Targets the right colon and small bowel — much fewer systemic side effects than prednisone.

**Methylprednisolone IV** 20-60 mg every 6-12 hours in hospital for severe flares.

**Swallowed steroids for EoE**: budesonide oral suspension or fluticasone inhaler swallowed (not inhaled).

• Severe psychiatric reaction (psychosis, severe depression, suicidal thoughts) — Stop steroid (under medical supervision) — emergency.

• Sudden vision change — Possible glaucoma or cataracts — see ophthalmology.

• Severe abdominal pain — Possible perforated ulcer or pancreatitis — emergency.

• Signs of infection (fever, cough, urinary symptoms) — Steroids mask and worsen infection — assess promptly.

• Adrenal crisis if stopped abruptly: severe weakness, low blood pressure, vomiting — Emergency. Never stop systemic steroid suddenly after >2 weeks of use.

Many. Steroids reduce effect of vaccines (avoid live vaccines). Increase blood sugar (adjust diabetes meds). Reduce effectiveness of blood pressure meds. Increase ulcer risk with NSAIDs. Reduce calcium absorption (need supplementation). Many CYP3A4 interactions.

Short course: blood pressure, blood sugar in diabetics. Longer term: bone density (DEXA), eye exam, blood pressure, blood sugar, weight, mood. Calcium + vitamin D supplementation if >3 months use.

Steroids must ALWAYS be tapered after >2 weeks of use — never stopped abruptly. Sudden withdrawal causes adrenal crisis. Use for shortest duration possible. Bridge to a steroid-sparing maintenance therapy (azathioprine, biologic, mesalamine) so you don't need long-term steroids.

Steroids can be used in pregnancy when needed. Cleft palate risk slight in first trimester (small absolute risk). Budesonide preferred when possible due to limited systemic absorption.

• How long is my steroid course, and what's the taper plan?

• Do I need calcium and vitamin D supplements?

• What's my "steroid-sparing" plan to avoid long-term use?

• Should I use budesonide instead of prednisone if eligible?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Patient Education Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.