Budesonide
The steroid pill you're asking about is budesonide, which is available in a 1 mg formulation.
Available Formulations
Budesonide comes in several oral formulations, including:
- 1 mg orodispersible tablets (dissolve in mouth)
- Capsules in various strengths (typically 3 mg, 6 mg, 9 mg for gastrointestinal conditions)
- Nebulizer solutions that can be swallowed (0.5 mg per 2 mL)
Clinical Applications
The 1 mg formulation is primarily used for:
Eosinophilic Esophagitis
Budesonide 1 mg twice daily (2 mg total daily dose) is highly effective for inducing remission in eosinophilic esophagitis 1, 2. Real-world data shows 75.1% clinical-histological remission rates with this dosing 2.
Gastrointestinal Inflammatory Conditions
- Ulcerative colitis: Budesonide 9 mg once daily is suggested when 5-ASA fails or is not tolerated 3, 4
- Crohn's disease: Budesonide 9 mg daily is recommended for mild-to-moderate disease in the ileum/ascending colon 5
- Immunotherapy-induced diarrhea: Grade 2 diarrhea can be treated with budesonide 9 mg once daily 6
Other Uses
- Epidermolysis bullosa with esophageal strictures: Oral viscous budesonide 1-2 mg daily may prevent stricture progression 7
- Autoimmune hepatitis: Budesonide 6-8 mg/day can be used in selected patients intolerant to standard therapy 8
Key Pharmacological Properties
Budesonide is a second-generation corticosteroid with 15 times the affinity of prednisolone for glucocorticoid receptors 8. It undergoes 90% first-pass hepatic metabolism, resulting in potent local anti-inflammatory effects with minimal systemic exposure 3, 9.
Safety Profile
- Generally well-tolerated with fewer systemic corticosteroid effects than prednisone
- Most common side effect: Oral and esophageal candidiasis, particularly with orodispersible formulations 7, 2
- Long-term monitoring needed: Potential for HPA axis suppression and growth effects in children, though studies show minimal impact even with high-dose nasal irrigations 10, 1
- Pregnancy category: Generally considered compatible (Category A/B depending on formulation) 11