Prednisone is a corticosteroid that doctors prescribe for some people with ulcerative colitis (UC). It has significantly improved outcomes for people 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. It causes the lining of the colon to become inflamed and develop sores known as ulcers.

Prednisone is a corticosteroid that doctors have used for many years to treat UC.

Corticosteroids have helped reduce the mortality rate of UC, which was about 61% in the 1960s. The National Institutes of Health (NIH) report that the current mortality rate for people with UC is not greater than that of the rest of the population.

The potential severity of this medication’s side effects makes it less desirable as a long-term treatment. Still, prednisone and other corticosteroids can play an important role in treating UC symptoms during flares.

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.

As the National Kidney Foundation notes, 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 effect on acute — severe and sudden — UC symptoms. The drug’s powerful anti-inflammatory properties mean that it can help control stomach 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. But 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 is formulated for immediate or delayed release.

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

Research from 2018 has shown that prednisone is not effective in maintaining UC remission. As a result, experts recommend against using it during periods when UC symptoms are not present.

They also do not advise doctors to prescribe corticosteroids preemptively, which would allow people to self-medicate during flares. Instead, doctors should prescribe prednisone as needed.

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 and other corticosteroids can 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 can 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 medications, as well as 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 can include:

  • blood thinners
  • certain antibiotics
  • diabetes medication
  • diuretics
  • estrogen
  • 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)

Taking prednisone may also cause vaccines to have a reduced effect.

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

A person should also let the 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 often recommend other medications.

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:
    • 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 can include:
    • azathioprine
    • cyclosporine
    • tacrolimus
    • 6-mercaptopurine
  • Janus kinase, or JAK, inhibitors: These oral medications, which include tofacitinib (Xeljanz) and upadacitinib (Rinvoq), block a specific enzyme responsible for inflammation. They can be effective in treating 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:
    • adalimumab
    • golimumab
    • infliximab
    • ustekinumab
    • vedolizumab

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, a person 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.

Let a doctor know about new or worsened UC symptoms. Also, never take leftover prednisone without first talking with a doctor.

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, and taking it for too long increases the risk of complications, including severe withdrawal symptoms.

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.