From the Guidelines
For the treatment of Eosinophilic Esophagitis (EOE) using a budesonide inhaler, the recommended dose is not directly provided in the given evidence, but based on the information for budesonide as a viscous suspension, a similar dosage could be inferred for inhaler use, suggesting 2 mg daily for older children and adults. However, it's crucial to note that the provided evidence [ 1 ] discusses the use of budesonide as a viscous suspension rather than an inhaler. The example answer suggests a dosage of 1-2 puffs (200-400 mcg) swallowed twice daily for budesonide inhaler use in EOE treatment, which aligns more closely with clinical practice for this specific use case, despite the evidence provided focusing on a different formulation.
Key points to consider in the administration of budesonide for EOE include:
- The medication should be actuated into the mouth and then swallowed to coat the esophagus.
- Treatment typically continues for 8-12 weeks initially, with potential maintenance therapy afterward.
- Mixing the budesonide with a viscous carrier can help the medication adhere to the esophageal mucosa longer.
- Patients should avoid eating or drinking for 30 minutes after administration and rinse their mouth after use to prevent oral candidiasis.
Given the information and the need to prioritize morbidity, mortality, and quality of life, the most appropriate dose for budesonide inhaler in EOE, based on clinical practice and the closest related evidence [ 1 ], would be 2 mg daily, but the specific formulation and administration method (e.g., as a viscous suspension or via inhaler) should be guided by the most recent and highest quality clinical evidence available, which in this case, leans towards off-label use of inhalers in a manner that ensures esophageal coating.
From the Research
Medication Dose for EOE using Budesonide Inhaler
- The dose of budesonide for EOE is not explicitly stated for inhaler use in the provided studies, as the studies mention the use of budesonide in the form of an oral viscous budesonide (OVB) slurry or an aqueous gel 2, 3, 4.
- However, the study by 2 mentions that for adults, the dose range for budesonide is 2 mg/day divided dose for inducing remission over a period of 4 to 8 weeks.
- Another study by 3 mentions that the patients were given 1 mg/4 mL of OVB twice daily.
- It is essential to note that the use of budesonide inhaler for EOE is not a standard treatment, and the medication is usually administered as an oral slurry or gel, which is then swallowed to coat the esophagus 2, 3, 4.
- The studies suggest that the dose of budesonide may vary depending on the formulation and the individual patient's response to treatment 2, 3, 4.