budesonide: clinical use

Prescribing considerations

• Confirm the indication, target site and formulation; products are not interchangeable.
• Check administration technique for the selected formulation.
• Easyhaler is preventive therapy and unsuitable for acute asthma symptoms.
• Jorveza treatment should be initiated by a gastroenterologist or clinician experienced in eosinophilic oesophagitis.
• Review total corticosteroid burden, potent CYP3A interactions, infection risk and whether a steroid treatment or emergency card is appropriate.
• When transferring from systemic corticosteroids, consider residual adrenal suppression and unmasking of previously controlled symptoms.

Contraindications and cautions

• Hypersensitivity to budesonide or product excipients.
• Easyhaler contains lactose with small amounts of milk protein and is contraindicated where this causes hypersensitivity.
• The selected nasal spray is contraindicated in haemostasis disorders or epistaxis and in oro-nasal or ophthalmic herpes infection.
• The selected suppository is contraindicated in hepatic cirrhosis.
• Jorveza should not be used in hepatic impairment because systemic exposure may increase.

Monitoring

• Assess disease control and administration technique before escalating treatment.
• Monitor growth in children receiving prolonged inhaled or intranasal corticosteroids.
• Consider adrenal function and systemic effects with prolonged or high exposure, transfers from systemic steroids, or potent CYP3A inhibitors.
• Review persistent candidiasis, recurrent infection, visual disturbance, and psychiatric or metabolic steroid effects.
• Inspect nasal mucosa periodically during continuous long-term nasal treatment.
• Consider blood pressure, glucose, bone and eye risk according to exposure and comorbidity.

Clinical pharmacology

Budesonide is a glucocorticoid-receptor agonist with strong local anti-inflammatory activity. It is primarily metabolised by CYP3A4 and undergoes extensive hepatic first-pass metabolism. Systemic exposure varies by route, formulation, liver function and interacting medicines.

Formulation and product differences

• Easyhaler is a lactose-containing dry-powder inhaler for persistent asthma.
• Nebuliser suspension is delivered through a suitable jet-nebuliser system when standard inhalers are unsuitable and is also licensed for hospital-managed croup.
• Aqueous nasal spray targets allergic nasal inflammation and adult nasal polyps.
• Jorveza is an orodispersible tablet designed to coat the oesophagus with budesonide-containing saliva.
• Entocort CR contains gastro-resistant prolonged-release granules targeting the ileum and ascending colon.
• Suppositories deliver budesonide directly to the rectum for ulcerative proctitis.

Inhaled preparation

Route: Inhaled

Strengths: 0.5 mg, 1 mg

Nasal preparation

Route: Nasal

Strengths: 64 micrograms, 64 micrograms/actuation