There are several different types and formulations of steroids allowing these drugs to be taken in a variety of ways. The choice depends on the location of your IBD and severity of symptoms.
Most commonly steroids are taken as tablets by mouth (orally). If your condition allows, oral steroids should be taken in the morning. This helps to reduce side effects and is less likely to affect your sleep. Budesonide tablets and granules, as well as any delayed release or enteric coated steroids, should be swallowed whole with a glass of water and taken around half an hour before food. This is important because chewing can destroy the way the drug is delivered.
For severe flare-ups steroids are given intravenously (injected into a vein) to achieve the quickest response. This only takes place in hospital. You will then be switched to oral steroids
For IBD affecting the lower part of the colon and rectum, steroids can be given as topical treatments that apply drugs directly to an affected area by enemas or suppositories. Enemas use a specially designed applicator (containing the drug as a liquid or foam) that is inserted into the anus (back passage) and reaches into the colon. Suppositories are small ‘bullet-like’ capsules of drug inserted into the rectum via the anus. One of the main advantages of topical treatments is their ability to directly target inflamed area. This means other parts of the body are not so affected, reducing side effects
Your IBD team will advise you on the correct dose depending on the type of steroid prescribed, your condition and weight. For prednisolone, for example, people are usually started on 40 mgs (eight tablets a day) taken as a single dose in the morning. But there can be considerable variations in doses prescribed. Talk to your IBD team before making any changes to your dose or how you take it.
People with severe flare-ups admitted to hospital normally receive methyl-prednisolone 60 mg over 24 hours or four infusions of hydrocortisone (100 mgs each dose) every day. Higher doses offer no greater benefits, but lower doses have been shown to be less effective.