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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice. Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. For patients with active Crohn's disease who are at high risk of corticosteroid side effects with, or intolerant of conventional steroids (e.g. prednisolone). Primary care prescribers should consider switching patients to budesonide rectal foam and for all new patients to use budesonide rectal foam moving forwards.

Steroid enemas should be reserved for those patients who do not respond to mesalazine. Please note prednisolone foam enemas are very high cost. Predsol retention enema 20mg/100ml rectal solution is a cost effective option.

Particular care is required when considering the use of systemic corticosteroids in patients with existing or previous history of severe affective disorders in themselves or in their first degree relatives. These would include depressive or manic-depressive illness and previous steroid psychosis. Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised. Beclometasone diproprionate is an additional option after an oral aminosalicylate in mild to moderate left sided or extensive ulcerative colitis . It may be considered for patients in whom the use of prednisolone would best be avoided.

The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing. Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. When you take prednisolone, you could begin to feel better within a few days.

Primary care prescribers should consider switching patients to budesonide rectal foam and for all new patients. It's rare to get serious side effects with budesonide rectal foam or enemas. Using budesonide rectal foam or enemas can mean you're more likely to get infections.

You'll usually use budesonide rectal foam or an enema once a day for 4 to 8 weeks. Live vaccines should not be given to individuals with impaired immune response as a result of treatment with large doses of corticosteroids. Increased risk of gastro-intestinal bleeding and ulceration with aspirin and NSAIDs; the renal clearance of salicylates is increased by corticosteroids and steroid withdrawal may result in salicylate intoxication. Prednisolone Rectal Solution provides local corticosteroid treatment and is indicated for rectal and rectosigmoidal disease in ulcerative colitis and Crohn's disease. This will signify that a product is not recommended for prescribing in both primary and secondary care.