Steroids for autoimmune hepatitis (AIH)
Autoimmune hepatitis (AIH), is a long-term liver condition, usually lifelong. Autoimmune means your body’s immune system (your body’s defence against illness) attacks your body’s own cells.
Steroids can help treat flares of AIH. They work by reducing inflammation in the liver.
Steroids are also known as corticosteroids and common types include prednisolone and budesonide.
Ideally, high doses of steroids should not be used for a long time because of possible side effects.
Before you start the medicine
You might need a few blood tests to make sure it's safe for you to start taking the medicine. These may include tests to check:
- your blood count
- liver and kidney function
- hepatitis B
- hepatitis C
Before starting steroids, you should also:
- tell us if you have not had chickenpox or if you are not sure if you have. You might get infections more easily while taking steroids, and chickenpox can be serious
- have the vaccine against strains of pneumonia. Your GP practice can arrange this for you
Other medicines you take
Steroids can interact with other medicines. Before you start taking steroids, let your doctor know about all the medicines you take. This should include anything prescribed for you and any medicines you buy from a shop or pharmacy, including herbal and homeopathic and anti-inflammatory medicines such as ibuprofen, diclofenac or aspirin.
While taking steroids, always check with your doctor or pharmacist before starting any new medicines. Make sure your GP, dentist or community pharmacist is aware you are taking steroids.
If you take any of these medicines we might need to make some changes or monitor you more closely.
- Phenobarbital, phenytoin, rifampicin, rifabutin, carbamazepine and primidone can reduce the effect of steroids in your body.
- Ketoconazole ritonavir, itraconazole, clarithromycin can increase the effect of steroids in your body.
- Medicines containing cobicistat should be avoided with certain steroids as it greatly increases the risk of steroid side effects.
- Diabetes medicine may need to be adjusted as steroids can increase blood sugar levels.
- Taking high doses of steroids with certain blood thinning medication, such as warfarin, can affect your INR (international normalised ratio). We may need to monitor you more closely and take blood tests more often.
- Anti-inflammatory medicines such as ibuprofen, diclofenac or aspirin can increase the risk of stomach irritation or developing stomach ulcers, if taken for long periods of time with steroids.
How to take steroids
Steroids will probably be taken by mouth (orally). Sometimes, when your disease is severe, you might be given by injection for a few days.
It is usual to start with a higher dose of steroid and for this to be gradually reduced over time. The time this takes will be different for each patient.
Some people might need to continue taking a low dose of steroids to control their inflammation. If this is the case, we try to find the lowest dose possible.
Once the inflammation is under control, steroids will be stopped and you will continue with a long-term medicine to stop your disease from flaring.
Never stop your steroids suddenly without speaking to a healthcare professional.
Prednisolone is available as tablets. The full dose should be taken in the morning where possible, as it can disturb your sleep.
Budesonide is available as capsules and can be taken 2 to 3 times throughout the day.
You should swallow the tablets or capsules whole with a glass of water.
If you forget to take a dose
Take your dose as soon as you remember, then continue your next dose as normal. If it is almost time for your next dose, don’t take the one you have missed.
Do not double your dose if you have forgotten.
Accidentally taking too many steroid tablets is not likely to be harmful if it only happens once but taking too many over a long period can make you more likely to get side effects. Speak to your doctor or pharmacist if you are worried.
Getting a repeat prescription
After your hospital specialist has started you on steroids, they'll advise your GP what dose to prescribe.
Your first prescriptions will be given to you by the hospital but ongoing supply will need to be from your GP.
If any changes to the dose are needed then the hospital will tell your GP.
Do not suddenly stop taking steroids without speaking to your medical team.
If you have been taking steroids for more than 4 weeks, or you have had repeated courses of steroids, you may need to reduce the dose gradually before stopping completely.
Staying safe while taking steroids
Regular blood tests
When you first start treatment our specialist doctors and pharmacists will monitor you. Please expect to have regular appointments and blood tests when you first start treatment.
As your disease becomes more controlled, you will not need appointments and blood tests as often.
Steroid emergency card
You will be given a steroid emergency card by your doctor or pharmacist. The card alerts healthcare staff that you are taking daily steroids as a critical medicine.
You should show this card to other healthcare professionals, such as dentists, that are treating you.
We recommend that you have the flu vaccine every year while taking steroids.
However, you should avoid ‘live’ vaccines when taking steroids. If you are considering vaccinations check with your doctor or pharmacist first.
We recommend you keep well within the national recommended limits of alcohol (maximum of 14 units per week).
14 units is about the same as 6 pints of average-strength beer or 10 small glasses of lower-strength wine.
Any amount of alcohol can damage the liver, especially if you have an underlying condition such as autoimmune hepatitis. Depending on the state of your liver, we may ask you to avoid alcohol completely.
Pregnancy and breastfeeding
The most important thing is that your AIH is as controlled as well as possible during pregnancy.
It's important you tell us if you are pregnant or planning on getting pregnant so that we can review all of your medicines and monitor you more closely.
Our team will be able to discuss the risks and benefits of continuing this medicine during pregnancy. Many people continue to take this medicine safely throughout their pregnancy.
The amount of prednisolone found in breast milk from mothers who were taking steroids and breastfeeding is very low. There have been no reports of side effects from steroids in these infants.
Your baby might be more closely monitored as a precaution if you are taking high doses of steroids for long periods of time while breastfeeding.
The British Liver Trust has information about autoimmune hepatitis.