Budesonide Dosage Recommendations by Condition
For asthma, allergic rhinitis, Crohn's disease, and ulcerative colitis, budesonide dosages vary by condition, with 9 mg once daily for ulcerative colitis, 9 mg once daily for Crohn's disease, 200-800 mcg twice daily for asthma in adults, and 400 mcg twice daily for allergic rhinitis.
Asthma Dosing
Adults
- For mild to moderate asthma in adults, the recommended dose is 200-800 mcg twice daily via metered dose inhaler, depending on severity 1
- Once-daily dosing (800 mcg) may be as effective as twice-daily dosing (400 mcg twice daily) in some patients with mild persistent asthma 2, 3
- However, for long-term maintenance of moderate asthma, twice-daily dosing provides better symptom control than once-daily dosing 4
Children
- For children 5-11 years: 200-400 mcg twice daily via metered dose inhaler 1
- For children under 4 years: 0.25-0.5 mg (250-500 mcg) twice daily via nebulizer 1, 5
- The FDA-approved budesonide inhalation suspension for children under 4 years should be administered twice daily 6
- Low daily dose: 0.25-0.5 mg total daily dose (0.125-0.25 mg twice daily) 6
- Medium daily dose: 0.5-1.0 mg total daily dose (0.25-0.5 mg twice daily) 6
- High daily dose: >1.0-2.0 mg total daily dose (>0.5-1.0 mg twice daily) 6
Crohn's Disease Dosing
- For mild to moderate ileal and/or right colonic Crohn's disease, oral budesonide should be started at 9 mg/day as first-line therapy to induce remission 7
- Patients should be evaluated for response between 4 and 8 weeks to determine if therapy modification is needed 7
- Once-daily dosing (9 mg OD) is as effective as three-times daily dosing (3 mg TID) for active Crohn's disease 8
- Budesonide is not recommended for maintenance of remission in Crohn's disease 7
Ulcerative Colitis Dosing
- For induction of remission in adults with active, mild to moderate ulcerative colitis, the recommended dosage is 9 mg taken orally once daily in the morning for up to 8 weeks 9
- Budesonide extended-release tablets should be swallowed whole and not chewed, crushed, or broken 9
- In patients with mild-moderate ulcerative colitis, standard-dose oral mesalamine or diazo-bonded 5-ASA is suggested rather than budesonide MMX for induction of remission 7
Allergic Rhinitis Dosing
- For allergic rhinitis in adults, the typical dose is 400 mcg twice daily via nasal spray 1
- Rinsing the mouth after use is recommended to prevent oral candidiasis 1
Administration Considerations
- For asthma treatment via nebulizer, use a jet nebulizer with a standard flow rate compressor 6
- For young children, use a face mask that fits snugly over the nose and mouth 6
- Wash the face after each treatment to prevent local side effects such as oral candidiasis 6
- For oral budesonide (Crohn's disease and ulcerative colitis), avoid grapefruit juice which inhibits CYP3A4 9
- If using with CYP3A4 inhibitors, monitor for increased signs of hypercorticism 9
Monitoring and Follow-up
- For asthma, assess response to budesonide between 2 to 8 days, although maximum benefit may not be achieved for 4 to 6 weeks 5
- For Crohn's disease, evaluate response between 4 and 8 weeks 7
- For ulcerative colitis, treatment duration is up to 8 weeks 9
- Monitor for local side effects such as oral candidiasis and dysphonia in patients using inhaled formulations 1
- In children, monitor growth as suppression of growth velocity has been observed with inhaled corticosteroid use 1