Budesonide is a corticosteroid medication that is used to treat various inflammatory conditions, particularly those affecting the respiratory system. It is commonly used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). Budesonide works by reducing inflammation and swelling in the airways, which helps to improve breathing and control symptoms such as wheezing, coughing, and shortness of breath.

Budesonide is available in several forms, including inhalers, nebulizer solutions, nasal sprays, and oral tablets. The most common way it's used for respiratory conditions is through inhalation, where it is delivered directly to the lungs to target inflammation in the airways.

One advantage of budesonide is that it has a lower risk of systemic side effects compared to some other corticosteroids because it primarily acts locally in the lungs.

Budesonide is a high-potency topical glucocorticoid that suppresses inflammatory mediators. It is used to treat the following conditions:

• For the maintenance and prophylactic treatment of patients with Asthma
• Mild to moderately active Crohn's disease involving the ileum and the ascending colon in patients older than 8 years of age
• For the induction of remission in patients with mild to moderately active ulcerative colitis.
• Off-label use for the treatment of eosinophilic esophagitis and protein-losing enteropathy.

Budesonide Dose in adults:

Budesonide For inhalational therapy in patients with Asthma:

• 400 - 2400 mcg in two to four divided doses initially, followed by a maintenance dose of 200 to 400 mcg twice a day.
• According to the NIH Asthma guidelines:
  • Low dose: 180 - 600 mcg per day
  • Medium dose: 600 - 1200 mcg per day
  • High dose: more than 1200 mcg per day

Budesonide use in the treatment of mild to moderately active Crohn's disease:  

For active Crohn's disease:

• You would take a capsule containing 9 milligrams of budesonide once a day in the morning for up to 8 weeks.
• If the symptoms come back after the first treatment, you can take another 8-week course.

For maintaining remission:

• After the active treatment, if your symptoms are under control (measured by a tool called the Crohn Disease Activity Index [CDAI] being less than 150), you can continue treatment with a lower dose of 6 milligrams once a day for up to 3 months.
• If your symptoms stay under control for these 3 months, your doctor might suggest gradually stopping the medication. Using budesonide for more than 3 months hasn't been shown to bring much additional benefit.

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Budesonide use in the treatment of active Ulcerative colitis:  

For active ulcerative colitis:

• You would take a tablet containing 9 milligrams of budesonide once a day in the morning for up to 8 weeks.
• This helps to reduce inflammation and symptoms associated with the condition.

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Budesonide off-label use in the treatment of Eosinophilic esophagitis:  

Dosage:

• You would take 2 milligrams of oral budesonide viscous liquid or suspension per day.
• This dose can be divided into two separate doses throughout the day.

Administration:

• It's important not to eat or drink anything solid or liquid for 30 minutes after taking the budesonide.
• This helps the medication work effectively in the esophagus.

Budesonide Dose in Children:

Budesonide For the treatment of Asthma in Children:

• Children 6 - 11 years of age:
  • 200 - 400 mcg in two divided doses initially, followed by the lowest effective maintenance dose.
  • According to the NIH Asthma guidelines:
    • Low dose: 180 - 400 mcg per day
    • Medium dose: 400 - 800 mcg per day
    • High dose: more than 800 mcg per day
• For nebulization in young children (12 months - 8 years):
  • 0.25 mg/day. The lowest effective dose should be used.
  • Patients previously treated with bronchodilators alone:
    • 0.5 mg/day administered in one or two divided doses.
  • Previously treated with inhaled corticosteroids:
    • 0.5 mg/day administered in one or two divided doses to a maximum dose of 1 mg daily.
  • Previously treated with oral corticosteroids:
    • 1 mg/day administered in one or two divided doses to a maximum daily dose of 1 mg daily.
  • According to the NIH Asthma Guidelines:
    • Children 0-4 years:
      • Low dose: 0.25-0.5 mg/day
      • Medium dose: 0.5 - 1 mg/day
      • High dose: more than 1 mg/day
    • Children 5-11 years:
      • Low dose: 0.5 mg/day
      • Medium dose: 1 mg/day
      • High dose: 2 mg/day

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Budesonide Use in the treatment of mild to moderate Crohn's disease:

Manufacturer's labeling:

• Children aged 8 years and older, as well as adolescents weighing more than 25 kilograms:
  • Initial dose: 9 milligrams orally once daily for up to 8 weeks
  • Maintenance dose: After the initial 8 weeks, the dose is reduced to 6 milligrams once daily for 2 weeks.

Alternate dosing (based on limited data):

• Children aged 6 years and older, as well as adolescents:
  • Induction: 9 milligrams orally once daily, or divided into doses every 8 hours, for 7 to 8 weeks. This is followed by a maintenance dose of 6 milligrams daily for 3 to 4 weeks. Therapy is stopped after a total duration of 10 to 12 weeks.
  • In another study involving patients aged 10 to 19 years, a slightly different dosing regimen was observed with an initial dose of 12 milligrams daily for 4 weeks, followed by 9 milligrams daily for 3 weeks, and then 6 milligrams daily for 3 weeks.

These dosing regimens aim to induce remission and then maintain it with a lower dose.

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Budesonide use in the treatment of Eosinophilic esophagitis: 

For Children under 10 years old:

• A viscous liquid or suspension is prepared using the inhalation suspension form of budesonide.
• Initial dose: 1 milligram orally once daily or split into two doses daily.

For Children 10 years old and older, as well as Adolescents:

• Similarly, a viscous liquid or suspension is prepared using the inhalation suspension form of budesonide.
• The dose is slightly higher:
  • Initial dose: 2 milligrams orally once daily or split into two doses daily.

After administering budesonide, it's important not to eat or drink anything solid or liquid for at least 30 minutes to allow the medication to have its desired effect in the esophagus. This treatment approach targets the inflammation locally in the esophagus.

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Budesonide use in the treatment of Protein-losing enteropathy following Fontan:

For Children aged 7 years and older, as well as Adolescents:

• Budesonide is usually given in capsule form, such as Entocort EC.
• Initial dose: 9 milligrams orally once daily or split into doses every 8 hours.
• After clinical improvement and when the albumin level in the blood is above 3 grams per deciliter (g/dL), the dose may be gradually reduced over several weeks to 3 milligrams once daily or every other day.
• If, during the dose reduction process, the serum albumin level decreases to below 2.5 g/dL, further reduction should be halted, and a dosage increase may be considered.

It's important to note that dosing for children under 7 years old is based on very limited data. In one report, an initial dose of 6 milligrams once daily was recommended for children under 4 years old.

Pregnancy Risk Factor B (Inhalational use), C (oral capsules and tablets)

• Some studies suggest that using corticosteroids during the first trimester of pregnancy might increase the risk of oral clefts in babies, while others show conflicting results regarding effects on baby's growth.
• Newborns may also experience hypoadrenalism if their mothers’ used corticosteroids during pregnancy.
• Therefore, when corticosteroids are necessary during pregnancy, doctors usually recommend using the lowest effective dose for the shortest time, especially avoiding high doses in the first trimester.
• Budesonide, a type of corticosteroid, may be used to treat inflammatory bowel disease in pregnant women, particularly for inducing remission, based on studies.

Use of budesonide while breastfeeding

• Budesonide can pass into breast milk, so when a mother is taking it, the decision to breastfeed should weigh the potential risk to the infant against the benefits of treatment for the mother.
• If there's concern about the infant's exposure to the medication, some guidelines suggest waiting for about 4 hours after the mother takes an oral corticosteroid before breastfeeding.
• This waiting period helps decrease the potential exposure of the breastfed infant to the medication, based on studies using prednisolone.

Budesonide Dose in Renal Disease:

• The manufacturer's labeling for budesonide does not include specific dosage adjustments for patient with kidney disease.

Budesonide Dose in Liver Disease:

Oral Capsule:

• Mild Hepatic Impairment (Child-Pugh class A): No need to change the dosage.
• Moderate Hepatic Impairment (Child-Pugh class B): Think about lowering the dosage to 3 milligrams once daily and watch out for signs of having too much cortisol in the body (hypercortisolism).
• Severe Hepatic Impairment (Child-Pugh class C): Don't use this medication.

Oral Tablet:

• Mild Hepatic Impairment: There aren't any specific changes to the dosage mentioned by the manufacturer; just be careful.
• Moderate to Severe Hepatic Impairment: There aren't any specific changes mentioned in the label (they haven't studied it much); watch out for signs of having too much cortisol in the body and consider stopping the medication.

Common Side Effects of Budesonide Include:

• Central Nervous System:
  • Headache
• Dermatologic:
  • Acne Vulgaris
• Endocrine & Metabolic:
  • Decreased Cortisol
  • Bruise
  • Moon Face
• Gastrointestinal:
  • Nausea
• Respiratory:
  • Respiratory Tract Infection

Less Common Side Effects of Budesonide Include:

• Cardiovascular:
  • Chest Pain
  • Edema
  • Facial Edema
  • Flushing
  • Hypertension
  • Palpitations
  • Tachycardia
• Central Nervous System:
  • Dizziness
  • Fatigue
  • Agitation
  • Amnesia
  • Confusion
  • Drowsiness
  • Insomnia
  • Malaise
  • Nervousness
  • Paresthesia
  • Sleep Disorder
  • Vertigo
• Dermatologic:
  • Alopecia
  • Dermatitis
  • Dermatological Disease
  • Diaphoresis
  • Eczema
• Endocrine & Metabolic:
  • Hirsutism
  • Hypokalemia
  • Intermenstrual Bleeding
  • Menstrual Disease
  • Weight Gain
  • Adrenocortical Insufficiency
  • Redistribution Of Body Fat
• Gastrointestinal:
  • Diarrhea
  • Dyspepsia
  • Anal Disease
  • Enteritis
  • Epigastric Pain
  • Exacerbation Of Crohn's Disease
  • Gastrointestinal Fistula
  • Glossitis
  • Hemorrhoids
  • Increased Appetite
  • Intestinal Obstruction
  • Oral Candidiasis
  • Upper Abdominal Pain
  • Flatulence
  • Abdominal Distention
  • Constipation
• Genitourinary:
  • Urinary Tract Infection
  • Dysuria
  • Nocturia
  • Urinary Frequency
  • Hematuria
  • Pyuria
• Hematologic & Oncologic:
  • Increase in C-reactive protein
  • Leukocytosis
  • Purpura
  • Abnormal Neutrophils
  • Anemia
  • Increased Erythrocyte Sedimentation Rate
• Hepatic:
  • Increased Serum Alkaline Phosphatase
• Hypersensitivity:
  • Tongue Edema
• Infection:
  • Viral Infection
  • Abscess
• Neuromuscular & Skeletal:
  • Ankle Edema
  • Arthralgia
  • Arthritis
  • Hyperkinesia
  • Muscle Cramps
  • Myalgia
  • Tremor
  • Weakness
• Ophthalmic:
  • Eye Disease
  • Visual Disturbance
• Otic:
  • Otic Infection
• Respiratory:
  • Sinusitis
  • Bronchitis
  • Dyspnea
  • Flu-Like Symptoms
  • Pharyngeal Disease
  • Rhinitis
• Miscellaneous:
  • Fever

Contraindications to Budesonide Include:

• Allergy to Budesonide: Don't use budesonide if you're allergic to it or any part of the medication.
• Cross-Reactivity: There isn't a lot of proof of cross-reactivity with other corticosteroids, but because they're similar, there might be a chance of a reaction.
• Additional Canadian Labeling: In Canada, there are extra reasons not to use budesonide, like having active tuberculosis, bacterial, fungal, or viral infections, or being allergic to soy, lecithin (which comes from soy or peanut oil), or peanuts (in the case of Cortiment).

Warnings and Precautions

Suppression of the adrenals:

• Budesonide can cause problems with the body's natural cortisol levels, especially in children or when used at high doses for a long time.
• This can lead to either having too much cortisol (hypercortisolism) or the body's adrenal system not working properly (HPA axis suppression), which might result in adrenal crisis.
• When stopping budesonide, it's important to do it slowly and carefully to avoid problems.
• If someone is switching from pills to inhaled forms or lower-dose steroids, they need extra attention because they might have adrenal insufficiency or experience steroid withdrawal, which can cause allergic symptoms to worsen.
• Adults taking more than 20 milligrams of prednisone per day are at the highest risk.
• In severe cases, asthma patients have even died because they didn't have enough steroid in their body after switching to inhaled steroids, which don't work the same way as pills and can't replace the steroids needed during illness, surgery, or trauma.

Anaphylactoid reactions

• In rare instances, people taking corticosteroids like budesonide may experience anaphylactoid reactions.
• These reactions are similar to allergic reactions but don't involve the immune system in the same way.

Immunosuppression:

• Long-term use of corticosteroids can weaken the immune system, making it easier for infections to happen or making existing infections worse.
• They might also hide signs of some infections or make vaccines less effective.
• It's important to avoid contact with chickenpox or measles while taking corticosteroids and not to use them for certain infections like ocular herpes simplex, cerebral malaria, fungal infections, or viral hepatitis.
• If you have latent tuberculosis or have recently been around someone with TB, your doctor needs to watch you closely.
• Before starting corticosteroids, doctors should check for amebiasis, especially if you've been to tropical areas or have unexplained diarrhea.
• Using corticosteroids with care is crucial if you have a Strongyloides infection because serious complications, including death, can occur.

Kaposi Sarcoma:

• Long-term use of corticosteroids has been linked to the development of Kaposi sarcoma, as shown in case reports.
• If signs of Kaposi sarcoma appear while on corticosteroid treatment, stopping the therapy should be considered.

Myopathy

• High doses of corticosteroids can sometimes lead to a condition called acute myopathy, especially in people with neuromuscular transmission disorders.
• This condition can affect muscles, including those in the eyes and breathing.
• Doctors may monitor levels of creatine kinase, a substance that rises when muscles are damaged.
• Recovery from myopathy might take longer than expected.

Psychiatric disorders:

• Using corticosteroids can sometimes lead to changes in mood or behavior, including feelings of euphoria, trouble sleeping, mood swings, or even more severe issues like depression or psychotic symptoms.
• People who already have psychiatric conditions might find that their symptoms get worse when they're taking corticosteroids.

Cardiovascular disease

• For patients with heart failure (HF) or high blood pressure (hypertension), corticosteroids should be used carefully.
• They can sometimes cause fluid retention, imbalances in electrolytes, and make blood pressure rise.
• After a heart attack (acute myocardial infarction or MI), corticosteroids should also be used cautiously because they've been linked to the risk of the heart muscle tearing (myocardial rupture).

Diabetes:

• Corticosteroids should be used carefully in patients with diabetes mellitus because they can affect how the body produces and regulates glucose, which might lead to high blood sugar levels (hyperglycemia).

Gastrointestinal Disease:

• Patients with gastrointestinal (GI) diseases such as diverticulitis, recent intestinal surgery, active or latent peptic ulcers, ulcerative colitis, or any type of gut infection should be cautious when using corticosteroids.
• These medications can increase the risk of perforation in the GI tract, so their use in these conditions should be carefully considered.

Hepatic impairment

• Patients with severe liver problems (Child-Pugh class C) should avoid using corticosteroids altogether.
• For those with moderate liver issues (Child-Pugh class B), the dosage might need to be reduced, and doctors should watch out for signs of having too much cortisol in the body (hypercortisolism).
• Using corticosteroids for a long time in patients with liver problems, including cirrhosis, has been linked to fluid retention.

Myasthenia gravis:

• Corticosteroids should be used carefully in patients with myasthenia gravis because they can sometimes make symptoms worse, especially when treatment starts.

Ocular disease:

• Patients with cataracts or glaucoma should be cautious when using corticosteroids because long-term use can lead to increased pressure inside the eye (intraocular pressure), open-angle glaucoma, and the development of cataracts.
• It's a good idea for people using corticosteroids for a long time to have regular eye exams.

Osteoporosis

• Patients with osteoporosis should use corticosteroids carefully because high doses or long-term use of these medications can lead to more bone loss and increase the risk of osteoporotic fractures.

Renal impairment

• Patients with renal impairment should be cautious when using corticosteroids because these medications can sometimes cause fluid retention.

Seizure disorders:

• Patients with a history of seizure disorders should use corticosteroids cautiously because there have been reports of seizures occurring during adrenal crisis, a condition where the body doesn't have enough cortisol.

Thyroid disease:

• Patients with thyroid disease should be aware that changes in their thyroid status might require adjustments to their corticosteroid dosage.
• In patients with hyperthyroidism, the body clears corticosteroids faster, so they may need higher doses.
• Conversely, in patients with hypothyroidism, corticosteroid clearance slows down, so they may need lower doses.

Budesonide (Systemic): Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Bile Acid Sequestrants	Might decrease the absorption of Corticosteroids (Oral)
Clofazimine	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Coccidioides immitis Skin Test	Coccidioides immitis Skin Test may be affected by immunosuppressants.
Corticorelin	Corticosteroids can reduce the therapeutic effects of Corticorelin. Recent or current corticosteroid treatment may affect plasma ACTH responses to Corticorelin.
Deferasirox	Corticosteroids can increase the toxic/adverse effects of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.
Denosumab	Might increase the toxic/adverse effects of Immunosuppressants. In particular, there may be an increase in the risk of serious infections.
Fosaprepitant	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Larotrectinib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Ocrelizumab	May increase the immunosuppressive effects of Immunosuppressants.
Palbociclib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Pidotimod	Pidotimod's therapeutic effects may be diminished by immunosuppressants.
Ritodrine	Ritodrine's toxic/adverse effects may be amplified by corticosteroids.
Simeprevir	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Siponimod	Siponimod's immunosuppressive effects may be enhanced by taking immunosuppressants.
Sipuleucel-T	Sipuleucel T's therapeutic effects may be diminished by immunosuppressants
Tertomotide	Tertomotide's therapeutic effects may be diminished by immunosuppressants.
Trastuzumab	May increase the neutropenic effects of Immunosuppressants.
Risk Factor D (Consider therapy modifications)
Antacids	Could decrease the bioavailability (Oral) of Corticosteroids. Management: It is worth separating doses for at least 2 hours. Budesonide enteric-coated tablets may dissolve prematurely when combined with lower gastric acid drugs, which have unknown effects on the budesonide therapeutic benefits.
Baricitinib	Baricitinib's immunosuppressive effects may be enhanced by immunosuppressants. Baricitinib should not be used in combination with immunosuppressants like azathioprine and cyclosporine. It is permissible to use methotrexate antirheumatically or nonbiologic disease-modifying antirheumatic drug (DMARDs), concurrently.
Echinacea	Might decrease the therapeutic effects of Immunosuppressants.
Fingolimod	Fingolimod may be immunosuppressed by immunosuppressants. When possible, avoid the use of fingolimod with other immunosuppressants. Patients should be closely monitored for any additive immunosuppressant effects, such as infections if they are used together.
Hyaluronidase	The therapeutic effects of Hyaluronidase may be diminished by corticosteroids. Management: Patients who are taking corticosteroids, especially at higher doses, may not have the desired clinical response to standard doses of hyaluronidase. Higher doses of hyaluronidase might be necessary.
Leflunomide	Leflunomide's toxic/adverse effects may be exacerbated by immunosuppressants. The risk of hematologic toxicities such as pancytopenia and agranulocytosis may increase. Patients on immunosuppressants should not be given a leflunomide loading dosage. Patients who are receiving leflunomide or another immunosuppressant must be checked for bone marrow suppression at a minimum monthly.
Nivolumab	Nivolumab's therapeutic effects may be diminished by immunosuppressants.
Roflumilast	May increase the immunosuppressive effects of Immunosuppressants.
Stiripentol	High risk of Inhibitors causing an increase in serum concentrations of CYP3A4 substrates. Management: Avoid stiripentol use with CYP3A4 Substrates that have a narrow therapeutic Index. This is to avoid adverse effects and toxicities. Monitoring of any CYP3A4 substrate that is used with stiripentol should be closely done.
Tofacitinib	Tofacitinib's immunosuppressive effects may be enhanced by immunosuppressants. Management: It is permissible to use methotrexate (or nonbiologic disease-modifying antirheumatic drug (DMARDs), concurrently with methotrexate. This warning appears to be particularly targeted at more potent immunosuppressants.
Vaccines (Inactivated)	Immunosuppressants can reduce the therapeutic effects of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. All age-appropriate vaccines must be completed at least two weeks before you start an immunosuppressant. Re-vaccinate anyone who was vaccinated while on immunosuppressant therapy.
Risk Factor X (Avoid Combination)
Aldesleukin	Aldesleukin's antineoplastic effects may be diminished by corticosteroids.
BCG (Intravesical).	The therapeutic effects of BCG (Intravesical) may be diminished by immunosuppressants
Cladribine	May increase the immunosuppressive effects of Immunosuppressants.
Conivaptan	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Moderate CYP3A4 inhibitors	Might increase serum Budesonide (Systemic) concentrations
Strong CYP3A4 inhibitors	Might increase serum Budesonide (Systemic) concentrations
Fusidic Acid (Systemic).	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Grapefruit Juice	Might increase serum Budesonide (Systemic) concentrations
Idelalisib	High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Natalizumab	Natalizumab's toxic/adverse effects may be exacerbated by immunosuppressants. Particularly, concurrent infections may increase.
Pimecrolimus	May increase the toxic/adverse effects of Immunosuppressants
Tacrolimus (Topical)	May increase the toxic/adverse effects of Immunosuppressants

Monitor:

• Serum Glucose and Electrolytes:
  • Keep an eye on blood sugar levels and electrolyte balance.
• Blood Pressure, Weight, and Growth Parameters:
  • Regularly check blood pressure, weight, and growth in children.
• Infection Presence:
  • Be vigilant for signs of infection, especially if using corticosteroids for a long time.
• Intraocular Pressure (IOP):
  • If corticosteroid therapy lasts more than 6 weeks, monitor intraocular pressure, especially in people with eye conditions.
• Bone Mineral Density:
  • Assess bone health with bone mineral density tests, especially in patients at risk of osteoporosis.
• HPA Axis Suppression:
  • Evaluate adrenal gland function with tests like the ACTH stimulation test, morning plasma cortisol test, or urinary free cortisol test, particularly in those on long-term therapy.

How to take Budesonide?

Oral administration:

• Capsule:
  • Take in the morning regardless of meals.
  • Swallow whole; don't crush or chew.
  • If needed, open the capsule and sprinkle granules onto 1 tablespoon of soft applesauce. Consume within 30 minutes of mixing; don't save for later use.
  • Follow with 8 oz of cool water.
• Tablet:
  • Swallow whole; don't crush, chew, or break.
  • Take in the morning regardless of meals.
• Viscous Liquid/Suspension:
  • Take the prepared liquid right away after making it.
  • Don't eat or drink anything solid or liquid for at least 30 minutes after taking budesonide.

Mechanism of action of Budesonide:

• Budesonide is a type of glucocorticoid medication that is highly potent when applied locally and has minimal effects on the rest of the body. It works by reducing the activity of certain natural substances involved in inflammation, such as kinins and prostaglandins. Oral forms of budesonide are used to target specific areas of the intestines affected by inflammatory bowel diseases like Crohn's disease and ulcerative colitis. The controlled-release capsule contains granules coated to dissolve in the ileum and ascending colon, while the multi-matrix enteric-coated tablet releases budesonide throughout the entire colon. This targeted release helps deliver the medication exactly where it's needed to treat inflammation in the intestines.

Distribution:

• In children aged 9 years and adolescents up to 14 years: 2.2 ± 0.4 L/kg intravenously.
• In adults: 2.2 to 3.9 L/kg.

Protein Binding:

• Budesonide is bound to proteins in the blood at a rate of 85% to 90%.

Metabolism:

• Metabolized in the liver by CYP3A4 into two less active substances: 16 alpha-hydroxyprednisolone and 6 beta-hydroxybudesonide, both less than 1% as active as the original.

Bioavailability:

• Orally administered budesonide undergoes a high first-pass effect.
• Capsule bioavailability:
  • Children aged 9 years and adolescents up to 14 years: 3% to 17%.
  • Adults: 9% to 21%.

Half-life Elimination:

• Intravenous administration:
  • Children aged 9 years and adolescents up to 14 years: 1.9 hours.
  • Adults: 2 to 3.6 hours.

Time to Peak:

• Capsule:
  • Children aged 9 years and adolescents up to 14 years: Median time is 5 hours.
  • Adults: 0.5 to 10 hours.
• Extended-release tablet:
  • Peak time is 13.3 ± 5.9 hours.

Excretion:

• Eliminated from the body primarily through urine (60%) and feces as metabolites.

International Brands of Budesonide:

• Budenofalk
• Budeson 3
• Budeson 9
• Cortiment
• Cycortide
• Entocir
• Entocort
• Zentacort

Budesonide Brand Names in Pakistan:

Budesonide Inhaler 100 mcg in Pakistan
Budeform Hfa	Highnoon Laboratories Ltd.

 

Budesonide Inhaler 200 mcg in Pakistan
Budeform Hfa	Highnoon Laboratories Ltd.

 

Budesonide Inhaler 50 mcg/actu in Pakistan
Pulmicort	Barrett Hodgson Pakistan (Pvt) Ltd.

 

Budesonide Inhaler 200 mcg/actu in Pakistan
Pulmicort	Barrett Hodgson Pakistan (Pvt) Ltd.