WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Prednisolone rectal solution contains a corticosteroid (steroid) in a
liquid form designed to be administered directly into the rectum. Prednisolone
works by suppressing inflammation, reducing the activity of the immune cells
and inflammatory chemicals responsible for the damage to the bowel lining in
ulcerative colitis.
As a rectal preparation, it acts mainly at the inflamed bowel lining
locally, with much less absorption into the bloodstream compared to steroid
tablets. This targeted approach helps control inflammation in the rectum and
lower colon (proctitis and proctosigmoiditis) while reducing the whole-body
side effects associated with systemic steroid treatment.
It is used to treat active flares of proctitis (rectum only) or
left-sided ulcerative colitis when the inflammation is limited to the lower
bowel and accessible by rectal administration.
3. HOW TO TAKE THIS MEDICINE
Insert one unit (20mg / 100mL) into the rectum once daily, usually at
bedtime. The solution is administered by attaching the nozzle to the pack and
gently inserting it into the rectum. Lie on your left side to administer it and
try to retain the solution for as long as possible — ideally all night. A
course of treatment typically lasts 2 to 4 weeks.
Do not use for longer than prescribed without review — prolonged steroid
use carries risks.
Empty your bowels if possible before using the enema. Lie on your left
side with knees slightly bent to help insertion and retention. After inserting
the nozzle and releasing the solution slowly, remove the pack and remain lying
still for at least 30 minutes — ideally sleeping with it in. The longer the
solution remains in contact with the bowel lining, the better the
anti-inflammatory effect.
⚠ PATIENT TIP: Unlike mesalazine enemas (entries
146/147) which can be used long-term, prednisolone rectal solution is a
short-course treatment for active flares only. Do not use it for longer than
your doctor has prescribed — corticosteroids used rectally over prolonged
periods can cause local and systemic side effects.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Common (local) |
Mild local irritation
or discomfort in the rectum after insertion. Urgency or feeling of wanting to
open the bowels shortly after use. |
|
With Prolonged Use |
Systemic steroid
effects — although rectal prednisolone is absorbed less than oral steroids,
prolonged use can still cause: weight gain, fluid retention, raised blood
sugar, mood changes, sleep disturbance, increased appetite. Adrenal
suppression with very prolonged courses. |
|
Rare |
Rectal bleeding, local
infection, worsening of existing bowel infection. |
5. WHO SHOULD NOT TAKE THIS MEDICINE
This preparation should not be used in patients with active bowel
infections (including bacterial, viral, or parasitic infections — particularly
amoebic colitis), as steroids can suppress the immune response and worsen
infections. Avoid in patients with bowel obstruction or perforation. Use with
caution in patients with diabetes (steroids raise blood sugar), high blood
pressure, glaucoma, or a history of osteoporosis.
⚠ SHORT-COURSE USE ONLY: Prednisolone rectal
solution is prescribed for flares and should not be used indefinitely. Follow
the prescribed course duration — if symptoms have not improved after 2 to 4
weeks, contact your gastroenterologist for a reassessment rather than
continuing the steroid.
⚠ DO NOT STOP ABRUPTLY IF ON PROLONGED COURSES:
If you have used rectal prednisolone for more than a few weeks, do not stop
suddenly without your doctor's advice — the adrenal glands may need time to
readjust. Your gastroenterologist will guide tapering if needed.
⚠ BOWEL INFECTIONS: If you develop worsening diarrhea,
fever, or blood in the stool during treatment, stop the preparation and contact
your doctor — these could indicate a bowel infection that is being masked or
worsened by steroid treatment.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Systemic steroid absorption is low from rectal preparations but not zero
— particularly with longer courses. Blood sugar monitoring is recommended in
diabetic patients. NSAIDs increase the risk of bowel bleeding and ulceration
when combined with corticosteroids and should be avoided in active colitis.
Live vaccines should not be given during steroid treatment.
7. HOW TO STORE THIS MEDICINE
Store below 25°C. Do not refrigerate. Keep in the original packaging.
Keep out of reach of children.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — prescribed by gastroenterologists or GPs with specialist
guidance |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
Use one pack each evening at bedtime. Empty your bowels first if you can.
Lie on your left side to insert the nozzle gently, release the liquid slowly,
and try to hold it in all night. Most people find it gets easier after the
first few days.
Use for the full course your gastroenterologist has prescribed — but do
not continue beyond the prescribed period without review. If you notice
worsening symptoms, fever, or increased bleeding during treatment, contact your
gastroenterologist promptly. If you are diabetic, monitor your blood sugar more
frequently during the course.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Rectal prednisolone
sodium phosphate — corticosteroid topical enema for active
proctitis/left-sided UC flare. Short-course treatment only (typically 2–4
weeks). Systemic absorption is significant enough to require caution in
diabetes (blood glucose monitoring), hypertension, glaucoma, and osteoporosis
with prolonged use. Counsel on correct administration technique (left lateral
position, slow instillation, maximum retention time). Room temperature only —
cold enemas are uncomfortable and poorly retained. Do not prescribe in
confirmed bowel infection — rule out C. difficile and other pathogens before
steroid therapy in any uncertain case. Gradual taper guidance if course
exceeds 3–4 weeks. Adrenal suppression risk with prolonged use. Not a
maintenance treatment — if ongoing bowel inflammation persists, mesalazine or
systemic therapy review is required. |
11. FREQUENTLY ASKED QUESTIONS
Q: How long will I need to use this?
A typical course is 2 to 4 weeks for an active flare. It is not a
long-term maintenance medicine — once the flare settles, treatment is usually
stopped or switched to a mesalazine preparation for ongoing maintenance.
Q: What if I can't retain the solution overnight?
This is common at first, especially during a flare when the bowel is very
irritated. Even holding it for 15 to 30 minutes provides some benefit. As the
inflammation settles over the first week, retention usually becomes easier.
Emptying the bowels before use also helps.
Q: Will it affect my blood sugar?
Although less than oral steroids, rectal prednisolone can still slightly
raise blood sugar, particularly with longer courses or in people who are
already prone to high blood sugar or have diabetes. Monitor your blood sugar
more frequently during treatment if relevant.
Q: Can it make an infection worse?
Yes — corticosteroids suppress the immune response. If you have a bowel
infection (such as Clostridioides difficile) at the same time as a colitis
flare, using steroids can worsen the infection. If your symptoms deteriorate or
you develop a fever, stop the preparation and contact your doctor — a stool
test may be needed.