Klismacort (Prednisolone)

Prednisolone rectally is used to manage inflammatory conditions of the lower gastrointestinal tract.

• Ulcerative colitis: reduces colonic mucosal inflammation and promotes remission in distal disease.
• Proctitis: alleviates rectal inflammation, decreasing bleeding and discomfort.
• Distal Crohn’s disease: controls local inflammatory activity when disease is limited to the rectum or sigmoid colon.

• Prednisolone binds to intracellular glucocorticoid receptors, forming a complex that translocates to the nucleus and modulates gene transcription. This interaction suppresses pro‑inflammatory cytokine production, inhibits leukocyte migration, and decreases vascular permeability, resulting in potent anti‑inflammatory and immunosuppressive effects at the site of administration. It also down‑regulates expression of adhesion molecules and enzymes such as COX‑2, further limiting the inflammatory cascade.

Rectal prednisolone may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Rectal irritation or burning sensation
• Increased appetite and weight gain
• Mood changes such as irritability
• Insomnia or difficulty sleeping
• Elevated blood pressure
• Mild hyperglycemia

Serious or Rare Side Effects

• Adrenal suppression leading to insufficiency
• Severe infections including opportunistic pathogens
• Significant hyperglycemia or diabetic ketoacidosis
• Osteoporosis with long‑term use
• Cataracts or glaucoma development
• Anaphylactic or severe allergic reactions

Before prescribing Klismacort, clinicians should evaluate several safety considerations to minimize risks.

• Assess infection risk: screen for active or latent infections before initiating therapy.
• Monitor blood glucose: check fasting glucose or HbA1c in diabetic patients.
• Evaluate bone health: consider calcium and vitamin D supplementation for long‑term use.
• Use lowest effective dose: titrate to the minimal dose that controls symptoms.
• Avoid abrupt discontinuation: taper gradually to prevent adrenal crisis.
• Store at room temperature: keep in original packaging, protect from moisture and direct sunlight.

Prednisolone can interact with various medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase prednisolone levels and toxicity.
• Live vaccines: heightened risk of disseminated infection.
• Anticoagulants (warfarin): enhanced anticoagulant effect, increasing bleeding risk.
• NSAIDs: additive gastrointestinal irritation and ulcer risk.
• Diuretics (loop or thiazide): may exacerbate hypokalemia.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampin): may reduce prednisolone effectiveness.
• Antidiabetic agents: glucocorticoid may raise glucose, requiring dose adjustment.
• ACE inhibitors or ARBs: potential for potassium imbalance.
• Antihistamines: possible increased sedation.
• Non‑live vaccines: monitor immune response efficacy.