Budesonide for Inflammatory Bowel Disease

Budesonide (oral, rectal) delivers local steroid primarily to Gastrointestinal Tract
Each Budesonide formulation targets specific regions of the colon
High first pass metabolism of Oral Budesonide significantly limits any Systemic Corticosteroid effects

Background
1. All budesonide forms are expensive ($700 to $1600 in 2023)
2. Dosing is for adults unless otherwise specified
3. Decrease dose in severe liver Impairment
Budesonide Rectal Foam (Uceris Rectal Foam)
1. Delivers 2 mg/actuation (with 14 doses per canister)
2. Indicated for active disease in distal colon (induction)
  1. Affects only distal colon (last 15 to 20 cm)
3. Dose
  1. Start 1 actuation (2 mg) twice daily (in am, and at bedtime) for 2 weeks
  2. Next 1 actuation (1 mg) once daily at bedtime for 4 weeks
Budesonide Capsules (Enterocort EC)
1. Available as 3 mg capsule
  1. May open capsules and sprinkle on soft food
2. Indicated for active Crohns Disease in right colon (induction)
  1. Affects distal ileum and right colon
3. Dosing: Adults and children age >= 9 years
  1. Take 9 mg orally daily for 8 weeks
  2. May repeat 8 week course if needed in adults
  3. May finish with taper dose at 6 mg for additional 2 weeks
4. Dosing: Child age <8 years (off-label)
  1. Give 0.45 mg/kg up to 9 mg orally daily for 8 weeks
Budesonide Extended Release Tablets (Uceris XR Tablets)
1. Indicated for active disease throughout the colon (induction)
2. Dosing: Adults and children age >= 9 years
  1. Take 9 mg orally daily each morning for up to 8 weeks
Budesonide Viscous Suspension
1. Indicated in Eosinophilic Esophagitis
2. Dose 2 mg orally daily
  1. Decrease to 1 mg orally daily in age <10 years or height <5 feet