Is budesonide (corticosteroid) 32 micrograms (mcg) equivalent to 90 or 180 mcg in terms of dosage?

Budesonide Dosage Equivalence: 32 mcg vs 90 mcg vs 180 mcg

Budesonide 32 mcg is not equivalent to either 90 mcg or 180 mcg - these are different dosage strengths with different clinical applications depending on the formulation and condition being treated.

Budesonide Dosage by Formulation and Condition

Asthma Management (Inhaled Budesonide)

• According to asthma treatment guidelines, budesonide DPI (dry powder inhaler) comes in strengths of 90,180, or 200 mcg per inhalation 1
• Low daily dose for children 5-11 years: 180-400 mcg
• Low daily dose for adults: 600 mcg
• Medium daily dose for adults: >600-1200 mcg
• High daily dose for adults: >1200 mcg

Crohn's Disease (Ileal-release Budesonide)

• For mild to moderate ileocaecal Crohn's disease: 9 mg once daily for 8 weeks 1
• This formulation is specifically designed for ileal release to target intestinal inflammation
• A once-daily 9 mg dose is as effective as 3 mg three times daily 1

Eosinophilic Esophagitis (Orodispersible Budesonide)

• Maintenance therapy: 0.5-1.0 mg twice daily for adults 2
• For children: 1 mg/day if <150 cm or 2 mg/day if >150 cm 2
• Administration method is critical for efficacy with specific instructions for different formulations

Important Clinical Considerations

Formulation-Specific Bioavailability

• Budesonide formulations are not interchangeable on a mcg-per-mcg basis 1
• The 32 mcg strength is not mentioned in any of the guidelines provided, suggesting it may be a formulation for a specific condition or route of administration not covered in these guidelines
• Bioequivalence studies have shown that budesonide DPI-A 200 mcg and DPI-B 180 mcg have systemic absorption bioequivalence 3

Dosing Frequency Considerations

• For asthma: Twice-daily dosing of 400 mcg provides better control than a single daily dose of 800 mcg 4
• For Crohn's disease: Once-daily dosing of 9 mg is effective and equivalent to divided dosing 1
• For eosinophilic esophagitis: Twice-daily dosing is recommended for adults 2

Administration Route Impact

• Inhaled budesonide has a 90% first-pass hepatic clearance when swallowed 1
• Budesonide should not be used in cirrhotic patients when oral absorption is intended due to risk of systemic side effects 1
• Proper administration technique is crucial for efficacy, especially for inhaled and orodispersible formulations 2

Clinical Application

When prescribing budesonide, clinicians must consider:

1. The specific condition being treated
2. The appropriate formulation for that condition
3. The recommended dosage range based on disease severity
4. Patient-specific factors (age, weight, liver function)
5. Administration technique to ensure proper delivery

The 32 mcg strength mentioned in the question does not align with standard dosages in major guidelines for asthma, Crohn's disease, or eosinophilic esophagitis, suggesting it may be a specialized formulation or potentially a misunderstanding of the available dosage strengths.