Budesonide Tapering Schedule for Colitis
For patients with colitis, budesonide 3mg ER capsules should be tapered over 1-2 weeks after achieving remission, with maintenance therapy at the lowest effective dose if needed for recurrent symptoms. 1
Induction Therapy and Initial Dosing
- Budesonide is the first-line treatment for microscopic colitis, with a standard induction dose of 9mg daily for 8 weeks 1
- For mild to moderate ileocecal Crohn's disease, budesonide 9mg once daily for 8 weeks is recommended as first-line therapy 1
- Budesonide is highly effective with a more favorable side effect profile compared to systemic corticosteroids like prednisolone 1, 2
Tapering Recommendations
- After achieving remission, budesonide should be tapered over 1-2 weeks rather than abruptly discontinued 1, 3
- Abrupt discontinuation may lead to symptom recurrence, making a gradual taper important 3
- For microscopic colitis with recurrent symptoms, maintenance therapy should be at the lowest effective dose 1
Maintenance Therapy (If Needed)
- For patients with microscopic colitis who experience symptom recurrence after induction therapy, maintenance therapy with budesonide is strongly recommended 1
- Maintenance dosing typically starts at 6mg daily but should be tapered to the lowest effective dose in clinical practice 1
- A lower maintenance dose regimen of 3mg daily alternating with 6mg daily over 12 months has shown similar efficacy in maintaining clinical response 1
- Cessation of maintenance therapy should be considered after 6-12 months 1
Monitoring and Follow-up
- Patients should be evaluated for symptomatic response to budesonide between 4-8 weeks to determine need for therapy modification 3
- Although budesonide has low systemic bioavailability, prolonged use may predispose to bone loss 1
- Osteoporosis prevention and screening should be considered in patients requiring long-term maintenance therapy 1
Important Considerations and Cautions
- Budesonide should not be used for long-term maintenance therapy beyond 6-12 months as prolonged use is associated with significant adverse effects 3
- Up to one-third of patients with microscopic colitis may not require maintenance therapy after successful induction 1
- For Crohn's disease affecting the proximal colon, ileal-release budesonide is beneficial, but there is no evidence of benefit for more distal colonic inflammation 1
- In patients with more severe disease (CDAI >300), budesonide is inferior to prednisolone and may not be appropriate 1