Crohn’s disease

BSG Guidelines: Inflammatory bowel disease in adults

Prescribing Notes:

Due to the potential for erratic absorption from the gastrointestinal tract enteric coated tablets of prednisolone should be avoided.
For patients on long term oral steroids, the risk of osteoporosis should be considered.
Acute exacerbation of extensive disease requires systemic corticosteroids.
See the Healthcare Improvement Scotland website for details around the use of a Steroid Emergency Card.

History Notes

01/10/2026

Budesonide enemas removed as topical preparations not considered standard practice in this pathway,

15/04/2026

Regional formulary chapter launched.

Adalimumab should be prescribed by brand name in line with local guidance (where available). Prescribe in combination with a purine analogue (see separate pathway).

Infliximab should be prescribed by brand name. Prescribe in combination with a purine analogue (see separate pathway).

Ustekinumab should be prescribed by brand name in line with local guidance (where available).

Prescribing Notes:

Each Health Board will have a preferred brand of adalimumab, infliximab and ustekinumab – check to ensure the preferred one is chosen.
Refer to local board prescribing guidelines and MHRA Drug Safety Update (April 2023) on Janus Kinase (JAK) Inhibitors.
They should only be used in patients who have not responded to conventional therapy or who are intolerant of or have contraindications to conventional therapy.
Refer to SMC advice for individual medicines.
Ustekinumab may be utilised in preference to adalimumab and infliximab in older patients. Risankizumab and mirikizumab may be utilised in preference to upadacitinib in older patients.

History Notes

15/04/2026

Regional formulary chapter launched.

Purine analogue options to be prescribed in conjunction with adalimumab or infliximab.

History Notes

15/04/2026

Regional formulary chapter launched.