What is the use of budesonide?

From the Guidelines

Budesonide is recommended as a first-line treatment for mild-to-moderate ileocaecal Crohn's disease and microscopic colitis due to its efficacy in inducing remission with fewer side effects compared to other corticosteroids, as evidenced by a randomized double-blind trial and multiple meta-analyses 1.

Key Points

• Budesonide has high local anti-inflammatory effects with lower systemic absorption, resulting in fewer side effects compared to other corticosteroids.
• For inflammatory bowel conditions, oral formulations of budesonide are prescribed, often 9 mg once daily for up to 8 weeks for active disease.
• Budesonide is preferred for many conditions because it undergoes extensive first-pass metabolism in the liver, reducing the amount that enters the bloodstream.
• Common side effects may include throat irritation with inhaled forms, nasal dryness with nasal sprays, or headache and nausea with oral forms.

Treatment Recommendations

• For mild-to-moderate ileocaecal Crohn's disease, budesonide 9 mg once daily for 8 weeks is as effective as prednisolone in inducing remission, with significantly fewer side effects 1.
• For microscopic colitis, the American Gastroenterological Association recommends budesonide as a first-line treatment for induction and maintenance of clinical remission, with a strong recommendation and moderate quality of evidence 1.
• Maintenance therapy with budesonide 6 mg daily for 6 months resulted in a 66% lower relative risk of clinical relapse, with moderate-quality evidence 1.

Important Considerations

• Patients should always take budesonide as prescribed and not stop suddenly, as this can cause withdrawal symptoms.
• Osteoporosis prevention and screening should be considered in patients who require maintenance therapy with budesonide due to the potential risk of bone loss with prolonged use 1.

From the FDA Drug Label

Budesonide inhalation suspension is an inhaled corticosteroid medicine Budesonide inhalation suspension is a long-term maintenance medicine used to control and prevent asthma symptoms in children ages 12 months to 8 years. The main use of budesonide is as an inhaled corticosteroid for the treatment of asthma in children aged 12 months to 8 years, and also as an oral medication for the treatment of ulcerative colitis.

• Key points about budesonide include:
  • It is used to control and prevent asthma symptoms
  • It is not used to treat sudden symptoms of asthma
  • It may cause systemic corticosteroid effects, such as hypercorticism and adrenal suppression
  • Patients should be advised to use it at regular intervals, twice a day 2
  • It is also used to induce remission in patients with active, mild to moderate ulcerative colitis 3 3

From the Research

Budesonide Overview

• Budesonide is a widely used inhaled corticosteroid (ICS) with a favorable therapeutic ratio, available via a dry powder inhaler (Pulmicort Turbuhaler) and as a suspension for nebulization (Pulmicort Respules) 4.
• It is effective in controlling asthma in children, adolescents, and adults with mild-to-moderate asthma, and can be delivered effectively via a dry powder inhaler or as an inhalation suspension 5.

Efficacy and Safety

• Budesonide has been demonstrated to be well tolerated in the treatment of chronic asthma in patients as young as 12 months, with no effect on hypothalamic-pituitary-adrenal axis function, bone mineral density, cataract formation, or final adult height 5.
• Once-daily administration of budesonide achieves clinical efficacy comparable with that of twice-daily regimens in patients with mild-to-moderate asthma, and is equally effective when given in the morning or evening 4.
• The tolerability profiles of budesonide once-daily via Turbuhaler or as budesonide inhalation suspension are good and comparable with those for twice-daily dosing 4.

Therapeutic Uses

• Budesonide is effective and well tolerated as initial treatment for adults and children with mild asthma, and as maintenance therapy in patients with more severe asthma once asthma control has been achieved 4.
• It is also used in the treatment of seasonal allergic and perennial rhinitis, where it is more effective than disodium cromoglycate and at least as effective as beclomethasone dipropionate 6.
• The combination of budesonide/formoterol can be used as an as-needed reliever with anti-inflammatory properties, with or without regular maintenance for asthma 7.

Pharmacological Properties

• Budesonide has a rapid and high airway efficacy due to its balanced relationship between water solubility and lipophilicity, and its moderate lipophilicity shortens systemic exposure 7.
• Its unique property of intracellular esterification acts like a sustained release mechanism within airway tissues, contributing to its airway selectivity and a low risk of adverse events 7.