How often is Budecort (Budesonide) administered?

Budesonide Administration Frequency

Budesonide (Budecort) is typically administered twice daily (bd) for most formulations and indications. 1

Administration Guidelines by Formulation

Inhaled Budesonide for Asthma

• Dry Powder Inhaler (DPI): Administered twice daily for most patients 1
• Nebulized suspension:
  • For children <4 years: Can be administered twice daily 1
  • Compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer 1

Budesonide for Eosinophilic Esophagitis

• Adults: Orodispersible budesonide tablets at 0.5-1.0 mg twice daily for maintenance therapy 1, 2
• Children: Oral viscous budesonide (OVB) at 1 mg/day if <150 cm or 2 mg/day if >150 cm, either as a single dose or divided into two doses per day 1, 2

Dosing Considerations

Asthma Management

• Budesonide dosing depends on asthma severity, age, and formulation:
  • Low-medium dose range: Usually administered twice daily
  • Higher doses: May be divided into twice daily administration for better control 1
  • For maintenance therapy in mild asthma: Once-daily dosing may be sufficient after control is achieved 3

Gastrointestinal Conditions

• Microscopic Colitis: Budesonide 9 mg daily is recommended as first-line therapy, which can be administered once daily 1
• Eosinophilic Esophagitis: Twice daily administration is standard for maintenance therapy 1

Clinical Efficacy and Pharmacokinetics

• The efficacy of twice-daily administration has been well-established in multiple clinical trials 4
• A study comparing four-times-a-day versus twice-daily dosing found that twice-daily dosing was effective for most patients requiring ≤1200 mcg daily 5
• Once-daily administration may be effective for maintenance therapy in mild asthma but twice-daily dosing is generally preferred for moderate to severe asthma 3, 6

Important Administration Considerations

• Proper administration technique is crucial for efficacy
• For inhaled formulations, use of a spacer or valved holding chamber with non-breath-actuated MDIs is recommended 1
• Mouthwashing and spitting after inhalation decreases local side effects such as oral thrush 1
• For nebulized budesonide, use only jet nebulizers as ultrasonic nebulizers are ineffective for suspensions 1

Potential Adverse Effects

• Common side effects include cough, dysphonia, and oral thrush (candidiasis) 1
• At high doses, systemic effects may occur, though studies are not conclusive 1
• In children, low-to-medium doses may cause transient suppression of growth velocity 1

Pitfalls to Avoid

• Budesonide preparations are not interchangeable on a mcg or per-puff basis 1, 2
• Potent inhibitors of CYP 3A4 (e.g., ritonavir, ketoconazole) can increase systemic concentrations of budesonide 1
• Dose should be carefully titrated to the minimum effective dose once asthma control is achieved 1

While some formulations of budesonide may be administered once daily for certain conditions, the standard administration frequency for Budecort is twice daily (bd) for most indications.