Rx Update: March 2002
Mary Ross, R.Ph., M.B.A., Barbara Mutnick, R.Ph., M.H.P., Joan
Murhammer, R.Ph., Pharmacotherapy Evaluation and Consultation
Service, Department of Pharmaceutical Care
Peer Review Status: Internally Reviewed
Budesonide has been shown to be equal to or less effective than corticosteroids (i.e., prednisolone) for the standard treatment of active Crohn's disease, but causes a lower incidence of more serious glucocorticosteroid-related adverse effects. These adverse events include acne, easy bruising, moon face, swollen ankles, hirsutism, buffalo hump, and skin striae.
The most common side effects experienced by patients taking oral budesonide include headache, respiratory infection, nausea, back pain, dyspepsia, dizziness, abdominal pain, flatulence, vomiting, fatigue and pain.
Budesonide is available as 3 mg capsules. The recommended adult dose is 9 mg once daily in the morning for up to 8 weeks. Doses may be tapered to 6 mg daily for 2 weeks prior to cessation of therapy. For recurring episodes of active Crohn's disease, a repeat 8-week course of budesonide can be given. Although patients have been switched from glucocorticosteroids to budesonide therapy without signs of adrenal suppression, patients who are switched to budesonide from a glucocorticosteroid with high systemic availability should be closely monitored for symptoms of acute adrenal suppression. Systemic glucocorticosteriods should not be stopped abruptly and tapering can begin with the start of budesonide therapy.
Budesonide capsules are currently approved only for use in adults. Budesonide capsules should be swallowed whole and should not be crushed or chewed. Because budesonide is metabolized by the CYP3A4 enzyme system, grapefruit juice, a CYP3A inhibitor, can double the systemic exposure of oral budesonide. Patients taking oral budesonide should avoid grapefruit juice. The medication may be taken without regard to meals or other food.
Access to the online Formulary and Handbook (F&H) on multi-user computers throughout UIHC is available through the IPR Browser. The IPR Browser provides clinicians a fast way to access the F&H, as well as several other helpful resources, without having to sign on to the IPR system or open a web page.
To access the online F&H from any computer in UIHC, simply open the Informm Patient Record (IPR) program from the main menu or programs file and then select the IPR Browser button to the right of the sign-in. The onlineF&H is listed on the IPR Browser under the heading UIHC Clinical Practice Reference.