Budesonide: Uses and Dosages
Budesonide is a synthetic glucocorticoid with high topical anti-inflammatory activity and low systemic bioavailability, making it useful for various inflammatory conditions with fewer systemic side effects than traditional corticosteroids. 1
Inflammatory Bowel Disease
Ulcerative Colitis
- For mild to moderate ulcerative colitis, the recommended dosage is 9 mg taken orally once daily in the morning with or without food for up to 8 weeks 2
- Budesonide MMX is strongly recommended as an alternative first-line therapy to induce remission in patients with mild to moderate UC of any disease extent 3
- Budesonide extended-release tablets should be swallowed whole and not chewed, crushed, or broken 2
- Patients should be evaluated for lack of symptomatic response within 2 weeks to determine if therapy modification is needed 3
- Budesonide should NOT be used for maintenance therapy in UC as corticosteroids are ineffective for this indication and prolonged use is associated with significant adverse effects 3
Ulcerative Proctitis
- For ulcerative proctitis, topical budesonide can be used as suppositories, foam, or enemas 4
- 2 mg budesonide suppository may be slightly less effective than 4 mg dose in inducing clinical remission 4
- 4 mg budesonide suppository is non-inferior to 2 mg budesonide foam enema for inducing remission, though the suppository group may experience more adverse events 4
- Patients may prefer budesonide foam compared to enemas due to better tolerability and improved retention 4
Crohn's Disease
- For ileocecal Crohn's disease, ileal-release budesonide 9 mg once daily for 8 weeks is recommended to induce remission, with tapering over 1-2 weeks after remission is achieved 3, 1
- Clinical remission rates with 9 mg daily dosing range from 42-67% of patients with active Crohn's disease of the ileum, ileocaecal region, and/or ascending colon 1
- Patients should be evaluated for symptomatic response between 4 and 8 weeks 3
- Budesonide is not recommended for maintenance therapy in Crohn's disease 3
Microscopic Colitis
- Budesonide is the best-documented treatment for microscopic colitis 5
- It is effective in inducing remission in collagenous colitis, though its use in lymphocytic colitis is less well documented 5
Respiratory Conditions
Asthma
For children under 4 years of age (the only inhaled corticosteroid with FDA approval for this age group):
For children 5-11 years:
Rhinitis
- Intranasal budesonide (200 to 400 micrograms/day) relieves nasal symptoms in patients with seasonal allergic, perennial allergic, and vasomotor rhinitis 7
Eosinophilic Esophagitis
- For children with eosinophilic esophagitis, suggested starting doses range from 440-880 μg per day 6
- The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition suggests viscous budesonide doses of 1 mg/day for children less than 150 cm or 2 mg/day for children greater than 150 cm 6
- The American Gastroenterological Association recommends budesonide to be administered twice daily for eosinophilic esophagitis 6
Important Considerations and Precautions
Administration
- For asthma in young children, use a face mask that fits snugly over the nose and mouth 6
- Wash the face after each inhalation treatment to prevent local side effects such as oral candidiasis 6
- For ulcerative colitis, budesonide extended-release tablets should be swallowed whole with or without food 2
Drug Interactions
- Avoid concomitant use with CYP3A4 inhibitors (including ketoconazole and grapefruit juice) as these may increase systemic exposure to budesonide 2
- Monitor patients for increased signs/symptoms of hypercorticism if CYP3A4 inhibitors must be used 2
Contraindications and Warnings
- Contraindicated in patients with hypersensitivity to budesonide or any ingredients in the formulation 2
- Not recommended for use in cirrhotic patients or those with peri-hepatic shunting due to high risk of side effects 4
- Monitor for signs of hypercorticism and adrenal axis suppression, especially in patients with moderate to severe liver disease 2
- Budesonide may suppress the immune system and increase the risk of infection 2