From the Guidelines
Budesonide is recommended for the treatment of asthma and Crohn's disease, with specific dosing regimens depending on the condition being treated, as supported by the most recent and highest quality study 1.
Usage Guidelines and Dosing Recommendations
For asthma, adults typically use budesonide inhalers at 200-800 mcg twice daily, with the dose adjusted based on symptom control, as suggested by the expert panel report 3 (epr-3) guidelines for the diagnosis and management of asthma 1. Children usually receive lower doses, ranging from 100-400 mcg twice daily based on age and severity.
Crohn's Disease Treatment
For Crohn's disease, the standard oral dose for adults is 9 mg once daily for up to 8 weeks during active disease, followed by a tapering period, as recommended by the ECCO guidelines on therapeutics in Crohn's disease 1.
- The dose may be adjusted based on the patient's response to therapy, with a strong recommendation for using budesonide for the induction of clinical remission in patients with active mild-to-moderate Crohn’s disease limited to the ileum and/or ascending colon 1.
- Budesonide has been shown to be safe and effective in inducing clinical response and remission in patients with mildly active CD in the small and/or large intestine limited to the ascending colon, with a better safety profile compared to conventional steroids 1.
Maintenance Therapy
For maintenance therapy in Crohn's, 6 mg daily is often used, although the Canadian Association of Gastroenterology clinical practice guideline recommends against the use of oral corticosteroids to maintain complete remission, with a strong recommendation and low-quality evidence 1.
Administration and Monitoring
Patients should take the medication consistently at the same time each day, and inhaled forms should be followed by rinsing the mouth to prevent oral thrush. Abrupt discontinuation should be avoided; instead, doses should be gradually tapered under medical supervision to prevent adrenal insufficiency.
- The medication should be administered using a jet nebulizer, as ultrasonic nebulizers are ineffective for suspensions, and the dose may be administered 2 times daily for budesonide suspension, which is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 1.
From the FDA Drug Label
Budesonide inhalation suspension is an inhaled corticosteroid indicated for: Maintenance treatment of asthma and as prophylactic therapy in children 12 months to 8 years of age Recommended dosing based on previous therapy. Start with the lowest recommended dose: Bronchodilators alone: 0.5 mg once daily or 0.25 mg twice daily Inhaled corticosteroids: 0.5 mg once daily or 0.25 mg twice daily up to 0.5 mg twice daily Oral corticosteroids: 0.5 mg twice daily
The usage guidelines and dosing recommendations for Budesonide in treating conditions like asthma are as follows:
- Indications: Budesonide is indicated for maintenance treatment of asthma and as prophylactic therapy in children 12 months to 8 years of age.
- Dosing: The recommended dosing is based on previous therapy, starting with the lowest recommended dose.
- Dosage options:
- Bronchodilators alone: 0.5 mg once daily or 0.25 mg twice daily
- Inhaled corticosteroids: 0.5 mg once daily or 0.25 mg twice daily up to 0.5 mg twice daily
- Oral corticosteroids: 0.5 mg twice daily
- Administration: For inhalation use via compressed air driven jet nebulizers only (not for use with ultrasonic devices). Not for injection. However, there is no information in the provided drug labels about the usage guidelines and dosing recommendations for Budesonide in treating Crohn's disease 2 2.
From the Research
Usage Guidelines for Budesonide
- Budesonide is a glucocorticoid with high topical activity and low systemic bioavailability, making it suitable for treating inflammatory bowel disease and asthma with reduced systemic effects 3, 4, 5.
- For Crohn's disease, budesonide can be administered orally as a controlled ileal release formulation or rectally as an enema, with daily treatment producing endoscopic remission or improvement in 46 to 84% of patients 3.
- The recommended dosage for Crohn's disease is 9 mg/day for 8 weeks, which produces clinical remission in 42 to 67% of patients and significantly reduces Crohn's disease activity index scores 3, 4.
- For asthma, budesonide inhalation suspension is effective in improving control of asthma in young children with persistent asthma, with a dosage of 0.5 to 2 mg/day 6.
- In adults with persistent asthma, budesonide inhalation suspension < or =8 mg/day has been compared with inhaled budesonide 1.6 mg/day and fluticasone propionate 2 mg/day administered by metered dose inhaler, with greater improvements in asthma control occurring with budesonide inhalation suspension 6.
Dosing Recommendations
- The dosage of budesonide may vary depending on the condition being treated and the patient's response to therapy 3, 4, 6, 5, 7.
- For Crohn's disease, maintenance treatment with oral budesonide 3 or 6 mg/day increases the duration of remission, but does not appear to affect the 1-year relapse rate 3.
- For asthma, the dosage of budesonide inhalation suspension may need to be adjusted based on the patient's response to therapy, with a maximum dosage of 8 mg/day 6.
- Budesonide has a substantially reduced risk of corticosteroid-related side effects compared to conventional corticosteroids, making it a safer alternative for long-term treatment 5, 7.
Safety and Efficacy
- Budesonide has been shown to be effective in inducing remission in mild to moderate Crohn's disease, with a response rate similar to that of prednisolone 3, 4.
- The safety profile of budesonide is favorable, with a low incidence of adverse glucocorticoid-related effects and no significant impact on hypothalamic-pituitary-adrenal axis function 3, 6, 5.
- However, budesonide is not effective in maintaining remission in patients with Crohn's disease, and its use should be limited to induction therapy 7.