Preparation H Dosing for Crohn's Disease
Preparation H (over-the-counter hemorrhoid cream) is not an appropriate treatment for Crohn's disease and should not be used. If you are asking about hydrocortisone for Crohn's disease, the dosing depends entirely on disease severity and location.
Clarification: Hydrocortisone vs. Preparation H
Preparation H is a brand-name hemorrhoid product containing phenylephrine (a vasoconstrictor) and may contain low-dose hydrocortisone in some formulations, but it is not indicated for inflammatory bowel disease treatment 1. The therapeutic doses of corticosteroids needed for Crohn's disease are substantially higher than what any topical hemorrhoid preparation provides.
Appropriate Corticosteroid Dosing for Crohn's Disease
For Moderate to Severe Active Crohn's Disease (Oral Therapy)
- Oral prednisone 40-60 mg daily is the standard dose for inducing remission in moderate to severe Crohn's disease 1
- The higher end of this range (60 mg) should be used for more severe disease 1
- Taper gradually over 8 weeks according to severity and patient response; more rapid reduction is associated with early relapse 1
- Evaluate for symptomatic response between 2-4 weeks to determine need to modify therapy 1
For Severe Crohn's Disease Requiring Hospitalization (Intravenous Therapy)
- Intravenous hydrocortisone 400 mg/day (100 mg four times daily) OR methylprednisolone 60 mg/day are appropriate for patients with severe disease requiring hospitalization 1
- Hydrocortisone 400 mg/day is equivalent to methylprednisolone 80 mg/day 1
- Evaluate for symptomatic response within 1 week to determine need to modify therapy 1
- Treatment should not extend beyond 7-10 days as this carries no additional benefit 1
For Mild to Moderate Ileocecal Crohn's Disease
- Oral budesonide 9 mg daily is appropriate as first-line therapy for isolated ileo-caecal disease with moderate activity 1
- Budesonide is marginally less effective than prednisolone but has reduced systemic toxicity 1
- Evaluate for symptomatic response between 4-8 weeks 1
Critical Considerations and Pitfalls
Corticosteroids Have No Role in Maintenance Therapy
- Corticosteroids should never be used for long-term maintenance in Crohn's disease 1
- Approximately 50% of patients will either fail to respond (steroid-resistant) or become steroid-dependent at 1 year 2, 3
- Consider thiopurines (azathioprine 2-2.5 mg/kg/day) as steroid-sparing agents for patients requiring two or more corticosteroid courses within a calendar year 1
When to Escalate Beyond Corticosteroids
- If no adequate response to oral prednisone within 2 weeks, initiate advanced therapy (biologics or small molecules) 1
- For hospitalized patients on IV steroids, if no response within 1 week, consider rescue therapy or surgery 1
- Patients remaining on ineffective corticosteroid therapy suffer high morbidity; early identification of those likely to require surgery or rescue therapy is essential 1
Topical Corticosteroids Have Limited Role
- Topical mesalazine may be effective in left-sided colonic Crohn's disease of mild to moderate activity, but this is not standard first-line therapy 1
- Topical corticosteroid suppositories, foam, or enemas (hydrocortisone, prednisolone metasulphobenzoate, betamethasone, budesonide) exist but are primarily used in ulcerative colitis, not Crohn's disease 1
Concomitant Therapy Considerations
- Intravenous metronidazole is often advisable with IV steroids in severe disease, as it may be difficult to distinguish active disease from septic complications 1
- Antacids should be given regularly during high-dose steroid therapy to prevent gastritis 4
Bottom Line
If you meant over-the-counter Preparation H: Do not use it for Crohn's disease. If you meant prescription hydrocortisone for Crohn's disease: use oral prednisone 40-60 mg daily for moderate-severe disease, or IV hydrocortisone 100 mg four times daily for severe hospitalized disease, with a clear plan for tapering and transition to steroid-sparing maintenance therapy 1.