What to Know About Budesonide

A Corticosteroid Used to Treat Asthma, IBD, and Allergic Rhinitis

In This Article

Budesonide is a medication used in its inhaled form to treat asthma or taken as a pill or topical foam to treat inflammatory bowel disease (IBD). There are also budesonide nasal sprays used to treat allergic rhinitis (hay fever) or nasal polyps. Budesonide is a type of corticosteroid drug that works by reducing inflammation. While effective, budesonide may cause short- and long-term side effects, including an increased risk of infection and irreversible changes in vision or bone density.

Budesonide has been used in medicine since 1981 and is available under a variety of brand names. There are generic versions of most budesonide formulations.

Uses

Corticosteroids are a class of man-made drug that mimics the hormone cortisol produced by the adrenal glands. Cortisol, often referred to as the stress hormone, is involved in the body's "fight-or-flight" response and triggers immediate biologic changes when released during moments of emotional or physical stress.

Among its many properties, cortisol has potent anti-inflammatory effects. It does so by temporarily suppressing the immune system and stifling the release of inflammatory cytokines that can cause tissues to swell and become hyperreactive.

By mimicking the action of cortisol, corticosteroids like budesonide can relieve inflammation on-demand, either in specific areas of the body throughout the entire body.

Budesonide is not taken for the treatment of acute symptoms. Rather, it is used to temper the immune system so that it is less likely to overreact and trigger symptoms.

Budesonide can be delivered locally (as an inhalant or nasal spray), topically (by rectal foam), or systemic delivery (as an oral pill).

Budesonide in its various forms is approved for use in treating the following conditions:

  • Asthma can be treated with an inhaled form of budesonide, sold under the brand name Pulmicort or as a generic inhaler.
  • IBD, which encompasses Crohn's disease or ulcerative colitis, can be treated with either extended-release budesonide tablets or capsules or a rectal budesonide foam. These are sold under the brand names Uceris and Entocort EC, or as a generic.
  • Allergic rhinitis can be treated with a budesonide nasal spray, sold under the brand name Rhinocort and others. There are both prescription and over-the-counter formulations available.
  • Nasal polyps can be controlled with a budesonide nasal spray. It can also be delivered by nasal irrigation immediately following nasal polyp surgery to prevent the return of polyps.

Off-Label Uses

Budesonide inhalant is sometimes used off-label to treat chronic obstructive pulmonary disease (COPD). When used daily, budesonide can reduce the risk of severe exacerbations in people with severe respiratory obstruction due to emphysema or chronic bronchitis.

There are ongoing studies investigating the use of budesonide in treating eosinophilic esophagitis, a chronic allergic disease of the esophagus (feeding tube). There is currently a quick-dissolving oral tablet called Jorveza approved for use in Europe but not the United States.

Some doctors use budesonide inhalant off-label to treat severe eosinophilic esophagitis, although it is not formally approved for such use.

Before Taking

Budesonide is prescribed under specific conditions based on the stage or severity of the disease and other factors. This typically involves tests to classify the condition and determine whether budesonide is the appropriate option.

The general indications for budesonide use are as follows:

  • Asthma: Budesonide inhalant is prescribed as a daily controller medicine when a rescue inhaler alone is unable to control asthma symptoms. Pulmonary function tests (PFTs) and diagnostic questionnaires can help classify the stage of the disease and determine the appropriate dosage.
  • Crohn's disease: Entocort EC is used for the treatment of mild to moderate Crohn's disease and taken daily for up to five months to sustain remission. Blood tests, imaging studies, and endoscopic examinations may be needed to properly stage the disease.
  • Ulcerative colitis: Uceris is used to treat mild to moderate ulcerative colitis. Uceris rectal foam and Uceris pills are both used to achieve clinical remission. The same diagnostic tests used for Crohn's disease would be used to classify the severity of ulcerative colitis.
  • Allergic rhinitis: Budesonide nasal sprays can treat hay fever by reducing your sensitivity to pollens and other airborne allergens. They are used daily throughout the hay fever season and are prescribed when oral antihistamines fail to provide relief.
  • Nasal polyps: Budesonide nasal sprays can help reduce the size of smaller nasal polyps or prevent their return after a polypectomy. Before treatment can be started, the cause of the polyps must be established. Polyps caused by hay fever or asthma may benefit from treatment, while those caused by cystic fibrosis or eosinophilic granulomatosis may not.

Precautions and Contraindications

Budesonide is contraindicated for use if you have a known allergy to the corticosteroid or any of the other ingredients in the formulation. (Pulmicort Flexhaler, for example, contains milk powder which may cause a reaction in people with a severe milk allergy.)

There are certain situations in which budesonide may not be appropriate and should either be avoided or used with extreme caution:

  • Adrenal insufficiency: Because corticosteroids impair adrenal function, it should be used with caution in people with adrenal insufficiency (also known as Addison's disease). If used, the drug may cause cortisol levels to further plummet and trigger a potentially serious adrenal crisis.
  • Eye problems: The long-term use of corticosteroids can affect vision. People with glaucoma or cataracts should use budesonide with caution and have their eyes regularly checked for deterioration of vision.
  • Infections: Corticosteroids work by suppressing the immune system and can increase your vulnerability to certain viral, bacterial, fungal, or parasitic infections. People with acute infections, such as pneumonia, tuberculosis, candidiasis, or herpes simplex, should be treated (and confirm that their infection fully cleared) before starting budesonide.
  • Metabolic disorders: Corticosteroids can affect many of the body's hormonal functions, leading to adverse changes in metabolism. Long-term or high-dose budesonide should be used with caution in people with metabolic disorders such as uncontrolled hypertension (high blood pressure) and uncontrolled diabetes.
  • Measles and chickenpox: Corticosteroids can impair immune function to such a degree that it can turn a common childhood infection like measles or chickenpox into a potentially life-threatening event. To avoid this, have your child immunized before the start of budesonide treatment as per current vaccine recommendations.
  • Osteoporosis: Corticosteroids can cause the loss of bone density (osteopenia) and should be used with caution in people with osteoporosis.
  • Pregnancy: All forms of budesonide, with the exception of oral budesonide, are classified as Pregnancy Category C, meaning that the benefits of treatment may outweigh the risks. Oral budesonide is Pregnancy Category D, meaning the drug can be used but that pregnancy risks exist. Speak with your doctor to fully understand the benefits and risks before starting any form of budesonide.
  • Ulcers: Corticosteroids can cause the thinning of gastrointestinal tissues and increase the risk of perforation in some people. Individuals with peptic ulcers or gastrointestinal fistulas may need to avoid high-dose budesonide.

People with any of these conditions should be regularly monitored during treatment to identify problems before they become serious or irreversible.

Dosage

The recommended dosage of budesonide can vary by the disease being treated, the stage or severity of the disease, the user's age, and their prior treatment history.

Budesonide Recommended Dosages
Condition Drug Form Budesonide Strength Dosage
Asthma Plumicort Flexhaler Dry powder inhaler 90 mcg and 180 mcg Ages 6 and over: 2 puffs twice daily (total 180 mcg to 360 mcg daily)
  Pulmicort Respules Nebulized inhalant 0.25 mcg, 0.5 mcg, and 1.0 mcg Ages 12 months to 8 years: 0.5 mcg to 1.0 mcg in either one dose or two divided doses
Crohn's disease Entocort EC Extended-release capsule 3 mg Treatment: 9 mg daily for up to eight weeks
Maintenance: 6 mg daily for up to three months
Ulcerative colitis Uceris tablets Extended-release tablets 9 mg Treatment: 9 mg once daily for up to eight weeks
Maintenance: Not used
  Uceris foam Rectal foam 2 mg per metered dose Treatment: Two 2-mg doses per day for two weeks, followed by one 2-mg dose per day for four weeks
Maintenance: Not used
Allergic rhinitis  Rhinocort Aqua Nasal spray 32 mcg per metered dose Age 12 and over: 64 mcg to 256 mcg once daily
Ages 6 to 11: 64 mcg to 128 mcg once daily
Nasal polyps Rhinocort Aqua Nasal spray 32 mcg per metered dose As directed by a physician
Note: Doses are measured in milligrams (mg) or micrograms (mcg). One mg equals 1,000 mcg.

How to Take and Store

Depending on the formulation used, it can take days or weeks before the drug concentration is high enough to render the full benefits of treatment. It is important, therefore, to take the drug as prescribed without missing doses.

Because the drug half-life of budesonide is relatively short (meaning that it is excreted from the body quickly once it reaches its peak concentration), you need to take the drug on a strict schedule. If taken once daily, be sure to take it at the same time every day. If taken twice daily, space the doses exactly 12 hours apart.

If you miss a dose, take it as soon as you remember. If near the time of your next dose, skip the missed dose and continue as normal. Do not double up doses as this can increase the risk of side effects.

Budesonide can be taken with or without food. With that said, some people prefer taking oral budesonide with meals as it helps reduce the risk of nausea and stomach upset.

All budesonide formulations can be stored safely at room temperature, ideally between 69 degrees F and 77 degrees F. If traveling or away from home, the drug will remain stable at temperatures up to 86 degrees F. Do not store in direct sunlight or near a heat source.

Never use budesonide after its expiration date or if the consistency, color, texture, or smell of the drug is unusual. Keep the drug well out of the reach of children and pets.

Side Effects

Like all corticosteroids, budesonide can cause short- and long-term side effects. The risk is dose-dependent, meaning the side effects are more likely to occur with higher doses than lower doses. With that said, the prolonged use of any budesonide formulation can have a cumulative effect and manifest with side effects over time.

Common

The common side effects of budesonide vary by the drug. Budesonide inhalers and sprays tend to have fewer side effects as their exposure is limited to the airways. Budesonide foam is also more likely to cause side effects because it is well absorbed in the rectum.

Common Budenoside Side Effects
Medication Side Effects
Pulmicort Flexhaler

Common cold, nasal congestion, sore throat, upper respiratory infection, gastroenteritis ("stomach flu"), otitis media (middle ear infection), oral candidiasis (thrush)

Pulmicort Respules

Respiratory infections, otitis media, runny or stuffy nose, cough, gastroenteritis, conjunctivitis (pink eye), oral candidiasis, stomach ache, vomiting, nosebleed

Entocort EC Headache, respiratory infections, stomach upset, nausea, vomiting, diarrhea, back pain, joint pain, abdominal pain, dizziness, flatulence, fatigue, sinusitis (sinus infection), viral infections
Uceria tablets Headache, nausea, upper abdominal pain, fatigue, flatulence, abdominal distension, acne, urinary tract infections, joint pain, constipation, mood changes, insomnia, facial swelling ("moon face"), fluid retention, hirsutism (abnormal body hair growth), Addison's disease
Uceria foam Nausea, insomnia, acne, mood changes, depression, hyperglycemia (high blood sugar), increased blood pressure, dizziness, itching, fever, fluid retention, Addison's disease
Rhinocort Aqua Nosebleed, sore throat, coughing, runny nose, bronchospasm

Severe

Serious side effects can occur even with lower-dose formulations if they are used on an ongoing basis. Because the risks are especially high with oral budesonide and budesonide foam, these forms are not used for extended periods.

The excessive exposure to budesonide over the short-term or long-term can affect multiple organ systems, including the heart, lungs, brain, eyes, skin, digestive tract, and endocrine system. In some people, this may cause:

Let your doctor know if you're experiencing any signs of symptoms of these conditions while on budesonide. By flagging them early, your doctor will be better able to treat you or, at the very least, prevent further progression of your condition.

Warnings and Interactions

Because of its effects on bone growth, budesonide can impair growth in children. Toddlers are most affected by this and, once the impairment occurs, it can often be difficult for them to catch up.

Budesonide inhalants arguably pose the greatest risk because they are typically used on a long-term basis. Oral budesonide can also impair growth but is less commonly used in children as the average age of onset of IBD symptoms is between 15 and 30.

Children on long-term budesonide therapy should have their growth regularly monitored. If growth is severely impaired, medications like Zomacton (somatropin) may be used to stimulate growth.

If using budesonide for more than three weeks, never stop treatment abruptly unless your doctor tells you to. Doing so can not only cause withdrawal symptoms but trigger a disease relapse. At the same time, if you stop too quickly, your adrenal gland may not be able to "catch up" and restore cortisol levels, increasing the risk of an adrenal crisis.

To avoid withdrawal and other complications, the budesonide dose may need to be gradually tapered under the supervision of a doctor. Depending on the dose and duration of treatment, this may take weeks or months.

Drug Interactions

Budesonide can interact with many drugs. As with side effects, the budesonide dose can play a large role in how likely or severe an interaction will be.

Budesonide can readily interact with drugs that use the liver enzyme cytochrome P450 (CYP450) for metabolization. Because budesonide also relies on CYP450, it can "compete" with other drugs for access to the enzyme. This competition can cause drug concentrations to either plummet (reducing a drug's efficacy) or spike (increasing the risk of side effects).

Budesonide can also interact with drugs with no CYP450 activity, either by interfering with the drug's mechanism of action or amplifying side effects.

Drugs and substances known to interactive with budesonide include:

To avoid interactions, always let your doctor about any drug you are taking, whether they are prescription, over-the-counter, herbal, or recreational.

A Word From Verywell

As effective as budesonide is in treating asthma, IBD, allergic rhinitis, and nasal polyps, more is not necessarily better. Never exceed the prescribed dose or veer from the treatment plan without your doctor's approval. If the drug does not seem to be working, let your doctor know. If needed, the dose can be adjusted or an alternate drug may be found. If used inappropriately, budesonide may cause more harm than good.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. National Library of Medicine. Compound summary: Budesonide. In: PubChem. Updated 2020.

  2. Tashkin DP, Lipworth B, Brattsand R. Benefit:risk profile of budesonide in obstructive airways disease. Drugs. 2019;79(16):1757-75. doi:10.1007/s40265-019-01198-7

  3. AstraZeneca. Pulmicort Flexhaler 90 mcg, 180 mcg (budesonide inhalation powder). Updated April 2010.

  4. Elan Pharmaceuticals. Entocort EC (budesonide) capsules, for oral use. Updated April 2016.

  5. AstraZeneca. Rhinocort Aqua 32 mcg (budesonide) nasal spray. Updated December 2010.

  6. Kang TW, Chung JH, Cho SH, Lee SH, Kim KR, Jeong JH. The effectiveness of budesonide nasal irrigation after endoscopic sinus surgery in chronic rhinosinusitis with asthma. Clin Exp Otorhinolaryngol. 2017;10(1):91-96. doi:10.21053/ceo.2016.00220

  7. Emami Ardestani M, Klantar E, Azimian M. Comparison of the efficacy of budesonide nebulizer suspension and budesonide inhalation suspension in the treatment of acute exacerbation of chronic obstructive pulmonary disease. Tanaffos. 2018;17(2):96-102.

  8. European Medicines Agency. Assessment report Jorveza international non-proprietary name: budesonide. November 9, 2017.

  9. Greuter T, Alexander JA, Straumann A, Katzka DA. Diagnostic and therapeutic long-term management of eosinophilic esophagitis - Current concepts and perspectives for steroid use. Clin Transl Gastroenterol. 2018;9(12):e212. doi:10.1038/s41424-018-0074-8

  10. Santaurus, Inc. Uceris (budesonide) extended-release tablets, for oral use. Updated January 2013.

  11. Parle-Pechaera S. POwers L, St. Anna L. Intranasal steroids vs antihistamines: Which is better for seasonal allergies and conjunctivitis?. J Fam Pract. 2012 July;61(7):429-48.

  12. Janahi IA, Rehman A, Ul-Ain Baloch N. Corticosteroids and their use in respiratory disorders. In: IntechOpen. Updated December 20, 2017.

  13. Yasir M, Goyal A, Bansal P, Sonthalia S. Corticosteroid adverse effects. In: StatPearls. Updated April 13, 2020.

  14. Allen DB. Inhaled corticosteroids and growth: still an issue after all these years. J Pediatr. 2015;166(2):463-9. doi:10.1016/j.jpeds.2014.09.055

  15. Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr. 2015;169(11):1053-60. doi:10.1001/jamapediatrics.2015.1982

  16. Martinelli CE, Palhares HM. hrGH treatment of glucocorticoid-induced short stature in children. Arq Bras Endocrinol Metabol. 2008;52(5):809-17. doi:10.1590/s0004-27302008000500013

  17. Matoulkova P, Pavek P, Maly J, Vicek J. Cytochrome P450 enzyme regulation by glucocorticoids and consequences in terms of drug interactionExp Opin Drug Metabol Toxicol. 2014 Jan 23:10(3):425-35. doi:10.1517/17425255.2014.878703