Budesonide for treating Crohn's disease and ulcerative colitis

What is budesonide for inflammatory bowel disease (IBD)

Budesonide is one of a group of medicines called corticosteroids, more commonly referred to as steroids. Budesonide is regularly used as an alternative to conventional steroids in the treatment of inflammatory bowel diseases (IBDs) such as Crohn’s disease, ulcerative colitis, and microscopic colitis, as well as many other conditions.

How does budesonide work for Crohn’s disease and ulcerative colitis (UC) work?

Steroids are man-made versions of a hormone called cortisol that is naturally produced in your body. When you take higher doses of steroids than your body would produce on its own, it decreases the activity of your immune system, reducing inflammation in your body. 

Studies have shown that, whilst generally budesonide isn’t quite as effective as conventional steroids (such as prednisolone) in treating inflammation in Crohn’s disease and UC, it has fewer, less serious adverse effects1.

What are common brand names for budesonide?

Common brands of budesonide used in inflammatory bowel disease are:

  • Entocort
  • Budenofalk
  • Cortiment (Budesonide MMX (Multi-Matrix system))

How is budesonide for Crohn’s disease and UC different to other steroids?

In the treatment of inflammatory bowel diseases, budesonide is different to other steroids because it is targeted to work most effectively in the place where the treatment is needed, in your small bowel (small intestine) and your colon (part of your large bowel). It also has lower systemic bioavailability; in other words, very little budesonide gets into your bloodstream, and studies have shown that because of this, you are likely to experience fewer and milder side effects than with other steroids1.

Budesonide MMX is a new type of controlled-release budesonide capsule for the treatment of ulcerative colitis, which is targeted to work most effectively throughout your colon.      

Budesonide is also available as granules, and as a topical treatment for ulcerative colitis as liquid enemas, or as rectal foam.      

    

Why would I be prescribed Budesonide for inflammatory bowel disease?

Budesonide for Crohn’s disease

Budesonide and budesonide controlled ileocolonic release (CIR) (Entocort and Budenofalk) are used to induce remission (get you well) in patients with mild to moderate Crohn’s disease involving their ileum and/or ascending (right) colon. They are not licensed to be used in the treatment of ulcerative colitis.   

Budesonide for UC and microscopic colitis

Budesonide MMX (Cortiment) is used to treat mild to moderate ulcerative colitis in adults, where 5-aminosalicylic acid (5-ASA) treatment is not enough.

Budesonide liquid enemas and rectal foams are used to treat mild to moderate distal (left sided) UC, and ulcerative proctitis in patients who have not responded to topical 5-ASAs. 

Budesonide for pouchitis

Budesonide is sometimes used to treat chronic pouchitis (inflammation of the ileo-anal (J) pouch) in patients who have not responded to antibiotics.

Budesonide for inflammatory bowel diseases in children

Budesonide is not licensed for use in children for Crohn’s disease or UC, however doctors will often prescribe it for children if they consider it appropriate.


How do I take budesonide for inflammatory bowel disease? 

Your IBD team will give you detailed information on your dosage of budesonide for your inflammatory bowel disease and how often you should take it. You can also read the patient information leaflet included in every medicine packet.

Oral budesonide for crohn's disease and ulcerative colitis 

You will usually take budesonide tablets, capsules or granules once a day, in the morning, half an hour before breakfast. 

You should swallow budesonide capsules or tablets with a glass of water, and must not chew them as this could stop them working properly. Budesonide granules can be mixed into a small amount of food to make them easier to swallow, but they must not be chewed. 

Oral budesonide is usually prescribed as an eight week course of treatment, and your IBD team may ask you to reduce (taper) your dose gradually towards the end of your treatment. It is important you don’t suddenly stop taking budesonide, even if you feel better, as this could make you very unwell.

Topical budesonide for UC

Budesonide enemas are usually used once a day for between four and eight weeks. Budesonide rectal foam is usually used once a day for between six and eight weeks.

Budesonide enemas and rectal foams are inserted through your anus using a specially designed applicator, delivering medicine into your rectum and the lower part of your colon (large bowel). 

Steroid treatment card

When you are prescribed budesonide for inflammatory bowel disease, you may be given a blue ‘steroid treatment card’ which gives advice and information about your treatment, for you and any healthcare professionals who treat you. You should carry this with you whilst taking budesonide, and should always show it to whoever carries out any medical treatment on you (including dental work).


How long will budesonide take to work for Crohn’s disease or UC?

When you take budesonide you could begin to feel better quickly in a few days. However, it can take up to a month to take maximum effect. Stay in contact with your IBD team; everyone responds differently to medicines, and some people don’t respond at all.

Budesonide is generally only used for short periods of time, to induce remission or to help you feel better whilst longer-term (maintenance) treatments you may be taking at the same time start to work.

What do I need to know before taking budesonide for inflammatory bowel disease?

You will need some checks before you start taking budesonide for Crohn's disease or UC. You should tell your care team if:

  • You have any kind of infection, or are feeling unwell. This includes some infections that you have had in the past, for example tuberculosis or chicken pox. This is because steroids can make infections worse
  • You have any pre-existing conditions, such as a heart condition, liver or kidney problems, osteoporosis, mental health problems, high blood pressure, eye disease or diabetes
  • You're pregnant, planning to get pregnant or are breastfeeding (it doesn’t necessarily mean you cannot take budesonide)
  • You are having, or have recently had any vaccinations as budesonide can cause your body to respond differently to vaccines, or make them less effective
  • You have any wounds, or have had surgery as steroids can delay healing

Can I take other medicines whilst I’m taking budesonide for IBD?

Budesonide is often prescribed at the same time as other IBD medicines. This can include 5-ASAs (such as mesalazine or sulfasalazine), immunosuppressants (such as azathioprine or 6-mercaptopurine) and biologics (such as infliximab or adalimumab). You will usually take the budesonide for a short time, to quickly control your symptoms whilst you are waiting for the other medicines to work. Then you will gradually reduce (taper) your dose of budesonide, allowing the other medicine, called a maintenance treatment, to take over and keep you in remission.

Budesonide can interact with other medicines; this can cause the medicines to work differently, or can increase your risk of side effects with the budesonide. So it is really important you tell your IBD team if you are taking other medicines, including herbal treatments, over the counter medicines and complementary therapies.

Some medicines can block liver enzymes that normally break down budesonide, which can increase the amount of budesonide in your bloodstream, making side effects more likely. These include some anti-fungal medicines, and some antibiotics.

There is a chemical in grapefruit which can increase the amount of budesonide in your bloodstream. This can make side effects more likely, so it is best to avoid eating grapefruit, or drinking grapefruit juice, whilst taking budesonide.

You can access a comprehensive list of medicines that interact with budesonide in the UK BNF (British National Formulary) section of the NICE (National Institute for Health and Care Excellence) website2.

What side effects could I get whilst taking Budesonide for Crohn’s disease and ulcerative colitis?

Immediate side effects

If you experience any of these side effects, it could mean you are having an allergic reaction to budesonide. You should contact your IBD team straight away for urgent advice, or seek emergency medical help.

  • A rash
  • Severe itching
  • Severe dizziness
  • Difficulty breathing or chest tightness
  • Chest pain
  • Swelling of your face, lips, or tongue

When you take budesonide for inflammatory bowel disease it tends to cause fewer, milder side effects than conventional steroids. However, it is important to inform your IBD team if you experience any of the following:

Common short term side effects of budesonide:

  • Nausea
  • Heartburn
  • Headaches
  • Coughs, runny/stuffy nose, sore throat
  • Skin becoming thin and bruising more easily
  • Mood changes
  • Difficulty sleeping
  • Changes in your menstrual cycle

Less common, serious side effects of budesonide:

  • Muscle weakness/pain
  • Bone pain
  • Rounding of the face, known as moon face
  • Slower wound healing
  • Excess hair growth, particularly on your face
  • Mental health problems, such as depression or anxiety
  • Vision problems
  • Stomach pain
  • Unusual tiredness
  • Slow growth in children, if used over a long period of time

Budesonide works by decreasing the activity of your immune system. This can make it more likely for you to get infections, or for infections to become more serious. Take sensible precautions such as regular hand washing, and avoiding close contact with people who show signs of infection. Contact your IBD team for advice if you think you have an infection.

Funding to help in the production of this article was received from PredictSURE IBD, however they had no input into its content.

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