Budesonide (Oral — IBD)

How it works

Budesonide is a potent glucocorticoid with extensive first-pass hepatic metabolism, so modified-release formulations deliver topical anti-inflammatory action at the gut mucosa while limiting systemic corticosteroid exposure.

Prescribing in practice

• Despite lower systemic effects than conventional steroids, it can still suppress the adrenal axis, so do not stop abruptly after prolonged courses and provide steroid-sickness advice.
• Co-administration with potent CYP3A4 inhibitors substantially raises systemic budesonide exposure and should generally be avoided.
• It is for induction rather than long-term maintenance, and watch for systemic corticosteroid effects with extended or repeated use.

Monitoring

Monitor for systemic corticosteroid effects on prolonged use and review disease response to guide tapering within the IBD pathway.

Counselling the patient

• Swallow modified-release capsules whole as directed so the medicine releases in the right part of the bowel.
• Do not stop suddenly if you have taken it for a while; the dose should be reduced gradually.
• Carry a steroid alert card and mention this medicine if you become unwell or need surgery.

Evidence & guidelines

NICE guidance on Crohn's disease supports budesonide to induce remission in mild-to-moderate ileocaecal disease where its more favourable side-effect profile than prednisolone is relevant.