- Susceptibility to infection
- Weight gain (particularly increased fatty tissue on the face and upper trunk and back)
- Acne
- Excess hair growth
- High blood pressure (hypertension)
- Accelerated osteoporosis
- Cataracts and glaucoma
- Diabetes
- Wasting of the muscles
- Menstrual irregularities
- Upper gastrointestinal ulcers
- Personality change, including irritability, insomnia, psychosis, and depression; such emotional changes are sometimes severe enough to produce suicidal thoughts
- Growth may be retarded in children
Treatments are available for steroid-induced diabetes, swelling, and hypertension. Vaccines are available to help prevent influenza and pneumonia. Any infection should be treated promptly. Supplemental calcium and vitamin D are important to help preserve bone mass against osteoporosis. The newer oral steroids, such as budesonide, have far fewer and less severe side effects.
Withdrawing from Corticosteroids. Once the intestinal inflammation has subsided, steroids must be withdrawn very gradually in order to give the body time to recover its own ability to produce natural steroids. Withdrawal symptoms, including fever, malaise, and joint pain may occur if the dosage is lowered too rapidly. If this happens, the dosage is increased slightly and maintained until symptoms are gone. More gradual withdrawal is then resumed.
Mesalamine (5-Aminosalicylic Acid): Sulfasalazine and Other Preparations
Mesalamine is the common name of the compound 5-aminosalicylic acid or 5-ASA. This drug inhibits factors in the immune system, especially cytokines that cause inflammation. Mesalamine and its different preparations are very effective for IBD. Some evidence suggests that mesalamine reduces the risk for colon cancer. Mesalamine is not very effective in preventing recurrence in Crohn's disease, however.
Mesalamine has few side effects, but it is absorbed so quickly in the upper gastrointestinal tract that it usually fails to reach the colon if used orally and as a single drug. Other substances, therefore, are added to mesalamine or it is formulated so that it can reach the lower intestine before it is absorbed. Sulfasalazine (Azulfidine), which contains mesalamine and sulfapyridine (a sulfa antibiotic), is the standard preparation.
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