What is the dosage and usage of Budesonide for inflammatory conditions?

Budesonide Dosage and Usage for Inflammatory Conditions

For inflammatory bowel disease, budesonide should be dosed at 9 mg once daily for 8 weeks to induce remission, with specific formulations selected based on the disease location. 1, 2

Dosing for Crohn's Disease

• For mild to moderate ileocaecal Crohn's disease, use ileal-release budesonide (Entocort, Budenofalk) 9 mg once daily for 8 weeks 1
• Budesonide has shown similar efficacy to prednisolone (51% vs 52.5%) for inducing remission in mild-to-moderate ileocaecal Crohn's disease, but with significantly fewer side effects 1
• For active small bowel and ileo-caecal Crohn's disease, budesonide 9 mg/day for 8 weeks is recommended 1
• Once-daily 9 mg dosing is as effective as 3 mg three times daily 1
• After achieving remission, budesonide should be tapered over 1-2 weeks 1

Dosing for Ulcerative Colitis

• For mild to moderate ulcerative colitis, budesonide extended-release tablets 9 mg should be taken orally once daily in the morning with or without food for up to 8 weeks 2
• Tablets should be swallowed whole and not chewed, crushed, or broken 2
• For flaring ulcerative colitis, budesonide MMX 9 mg/day for 8 weeks is recommended 1
• For distal ulcerative colitis or proctitis, topical formulations are effective 1:
  • Budesonide suppositories: 4 mg dose is more effective than 2 mg for inducing clinical remission 1
  • Budesonide foam: 2 mg budesonide foam enema is non-inferior to 4 mg suppository 1

Special Considerations

• Budesonide has a 90% first-pass hepatic clearance and should NOT be used in cirrhotic patients or those with peri-hepatic shunting due to high risk of side effects 1
• If concomitant administration with ketoconazole or any other CYP3A4 inhibitor is necessary, patients should be monitored for signs of hypercorticism 2
• Avoid grapefruit juice when taking budesonide as it inhibits CYP3A4 2
• In pediatric Crohn's disease, a higher induction dose of 12 mg/day for the first month followed by standard dosing may result in higher remission rates (65.7% vs 42.9%) 3
• Budesonide is contraindicated in patients with hypersensitivity to budesonide or any ingredients in the formulation 2

Advantages Over Conventional Corticosteroids

• Budesonide has high topical anti-inflammatory activity but low systemic bioavailability 1, 4
• It causes less suppression of plasma cortisol levels than other glucocorticoids 4
• Budesonide has fewer systemic side effects compared to conventional steroids like prednisolone 1, 4
• In severe disease (CDAI >300), budesonide is inferior to prednisolone and should not be used 1

Monitoring

• Monitor for signs and symptoms of hypercorticism and adrenal axis suppression during treatment 2
• Patients with moderate to severe liver disease require closer monitoring for increased signs of hypercorticism 2
• Budesonide may increase the risk of infection, so patients should be monitored accordingly 2

Budesonide's favorable safety profile makes it an excellent first-line option for inducing remission in mild to moderate inflammatory bowel disease, particularly when the goal is to minimize systemic corticosteroid exposure while maintaining therapeutic efficacy 1, 4, 5.