Mode of action
Anti-inflammatory. Formulation delivers budesonide predominantly to the ileum and ascending colon. Systemic absorption is reduced by high first-pass metabolism, producing mainly local effects in the gut. However, some systemic effects occur.
Indications
Induction of remission in mild-to-moderate Crohn’s disease affecting the ileum and/or the ascending colon. Delay relapse during maintenance therapy for Crohn’s disease.
Specific considerations
Surgery: continue treatment throughout perioperative period. Depending on the type of surgery additional corticosteroid coverage may be needed to avoid adrenal crisis.
Children: not recommended.
Pregnancy: use if indicated; ADEC category B3.
Breastfeeding: limited data; appears safe.
Adverse effects
Infrequent and usually of mild-to-moderate severity. However, adrenal suppression may occur even with short courses of therapy. Despite limited data on prolonged therapy, the possibility of long term glucocorticoid adverse effects should be considered.
Dosage
9 mg once daily in the morning just before food.
Patient counseling
Swallow the capsules whole, do not crush or chew them.
Do not stop taking this medication suddenly.
Therapeutic effects may take 2–4 weeks to become apparent.
Avoid grapefruit as it may increase the risk of side effects with budesonide.
Practice points
budesonide has a favourable topical activity/systemic effects ratio which may offer benefit over
conventional corticosteroids high cost limits use transfer from a corticosteroid with significant systemic effects to budesonide requires cautious tailoring of
dose to avoid adrenal crisis wean budesonide slowly as for other corticosteroids.
Products
BUDESONIDE ENEMA 2 MG (ENTOCORT®, ENEMACORT®)
BUDESONIDE TABS 3 MG (ENTOCORT®)