Budesonide (Oral / Rectal)

How it works

Budesonide exerts topical glucocorticoid anti-inflammatory activity at the intestinal mucosa, and because of high first-pass hepatic metabolism it produces less systemic corticosteroid effect than conventional steroids; rectal formulations target distal disease directly.

Prescribing in practice

• Even with predominantly local action, systemic absorption can suppress the adrenal axis, so avoid abrupt cessation after prolonged use and give steroid-sickness advice.
• Rectal preparations are suited to distal colonic or rectal disease, whereas modified-release oral forms target the ileocaecal region, so match the route to disease location.
• Avoid combining with potent CYP3A4 inhibitors, which markedly increase systemic budesonide exposure.

Monitoring

No routine bloods are mandated for short courses, but monitor for systemic steroid effects on prolonged treatment and review the clinical response.

Counselling the patient

• Use the prescribed route exactly as directed; for rectal preparations, follow the administration instructions for best contact with the bowel lining.
• Do not stop abruptly after extended use, and carry a steroid alert card.
• Report signs of infection or feeling unwell, as steroids can mask or worsen them.

Evidence & guidelines

NICE guidance on inflammatory bowel disease supports topical-acting budesonide formulations, with route selected according to the site and extent of disease.