What is the typical dosage and usage of Budesonide (corticosteroid) for treating conditions such as asthma, Chronic Obstructive Pulmonary Disease (COPD), or inflammatory bowel diseases?

Budesonide Dosing and Usage

Inflammatory Bowel Disease (IBD)

For mild to moderate ileocecal Crohn's disease, use budesonide 9 mg once daily for 8 weeks to induce remission, then taper over 1-2 weeks. 1

Crohn's Disease - Ileocecal Location

• Initial dose: 9 mg once daily for 8 weeks 1
• Efficacy: Achieves remission in approximately 51% of patients, comparable to prednisolone but with significantly fewer side effects 1
• Tapering: After achieving remission, taper over 1-2 weeks rather than abrupt discontinuation 1, 2
• Important limitation: Budesonide is inferior to prednisolone in severe disease (CDAI >300) 1
• Location matters: Effective for proximal colon involvement, but no evidence of benefit for distal colonic inflammation 1

Ulcerative Colitis

• Budesonide MMX 9 mg once daily for mild to moderate disease, particularly effective for left-sided disease 1
• Alternative to prednisolone when patients wish to avoid systemic corticosteroids 1
• Response assessment: Evaluate within 2 weeks; if inadequate response, escalate therapy 3
• Not for maintenance: Budesonide should NOT be used for long-term maintenance in ulcerative colitis beyond 6-12 months 2, 3

Ulcerative Proctitis

• Topical budesonide: 2-4 mg suppository or foam enema 1
• Dose comparison: 4 mg suppository may be marginally superior to 2 mg (RR=0.74,95% CI 0.57 to 0.96) 1
• Formulation preference: Patients may prefer foam over enemas due to better tolerability and retention 1

Microscopic Colitis

• Standard induction: 9 mg daily for 8 weeks 2, 4
• Maintenance (if needed): Start at 6 mg daily, taper to lowest effective dose (often 3 mg daily or alternate-day dosing) 2
• Duration limit: Consider cessation after 6-12 months of maintenance therapy 2

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Asthma (Pediatric - Ages 12 months to 8 years)

For children with asthma, budesonide inhalation suspension dosing depends on prior therapy: 0.25-0.5 mg twice daily via jet nebulizer. 5

Dosing by Prior Therapy

• Bronchodilators alone: 0.5 mg total daily (0.25 mg twice daily or 0.5 mg once daily) 5
• Prior inhaled corticosteroids: 0.5 mg total daily (0.25 mg twice daily), up to maximum 1 mg total daily 5
• Prior oral corticosteroids: 1 mg total daily (0.5 mg twice daily) 5
• Symptomatic children not responding to non-steroidal therapy: May start with 0.25 mg once daily 5

Administration Requirements

• Must use jet nebulizer connected to air compressor with adequate airflow 5
• Do NOT use ultrasonic nebulizers - they are not suitable for adequate administration 5
• Administer separately - do not mix with other nebulizable medications 5
• Rinse mouth after use to reduce risk of oral candidiasis 5

Titration Strategy

• If once-daily dosing provides inadequate control, increase total daily dose and/or divide into twice-daily administration 5
• Once asthma stability is achieved, downward-titrate to lowest effective dose 5

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Asthma (Adults and Older Children)

For adults with asthma, budesonide dosing via metered-dose inhaler ranges from 176 mcg daily (low dose) to >352 mcg daily (high dose). 4

Dose Ranges by Severity

• Low dose: 176 mcg daily 4
• Medium dose: 176-352 mcg daily 4
• High dose: >352 mcg daily 4

Once-Daily Dosing Evidence

• Once-daily budesonide is effective for mild-to-moderate asthma and achieves comparable efficacy to twice-daily regimens 6
• Equally effective when given morning or evening 6
• May improve patient compliance through simplified regimen 6

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COPD

Budesonide is used in COPD primarily in combination with formoterol; specific dosing should follow combination product guidelines. 7

• Budesonide/formoterol combination is significantly more effective than budesonide alone in moderate-to-severe disease 7
• The combination can be administered once or twice daily depending on disease severity 7

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Critical Safety Considerations

Bone Health Monitoring

• Prolonged use may predispose to bone loss - consider osteoporosis screening and prevention in patients requiring maintenance therapy beyond 6 months 2, 4
• Recent evidence suggests long-term oral budesonide (up to 4 years) may not increase osteoporosis risk and may even stabilize BMD 8

Drug Interactions

• CYP3A4 inhibitors (ritonavir, ketoconazole) can significantly increase systemic budesonide concentrations and risk of Cushing syndrome 4

Local Side Effects

• Oral candidiasis, dysphonia, throat irritation - mitigate by rinsing mouth after inhalation 4, 5
• Face washing after inhalation reduces local adverse effects 4

Contraindications

• NOT for acute bronchospasm or status asthmaticus - budesonide is not a bronchodilator 5
• Hypersensitivity to budesonide or any ingredients 5

Duration Limits

• Do not use beyond 6-12 months for IBD maintenance due to adverse effects including adrenal suppression 2, 4