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Budesonide in the treatment of inflammatory bowel disease in adults

Authors
Mark A Peppercorn, MD
Adam S Cheifetz, MD
Section Editor
Paul Rutgeerts, MD, PhD, FRCP
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

Budesonide is a nonsystemic corticosteroid with high first-pass metabolism. This topic will review the pharmacology, indications, efficacy, and adverse effects of budesonide in the treatment of inflammatory bowel disease. The clinical manifestations, diagnosis, and management of patients with Crohn disease and ulcerative colitis are discussed in detail, separately. (See "Clinical manifestations, diagnosis and prognosis of Crohn disease in adults" and "Overview of the medical management of mild to moderate Crohn disease in adults" and "Overview of the medical management of severe or refractory Crohn disease in adults" and "Management of mild to moderate ulcerative colitis in adults" and "Management of severe ulcerative colitis in adults".)

PHARMACOLOGY

Budesonide is a corticosteroid structurally related to 16α-hydroxyprednisolone. Corticosteroids inhibit protein synthesis and transcription and downregulate the production of inflammatory cytokines. Budesonide has high topical anti-inflammatory activity but low systemic activity because of approximately 90 percent first-pass metabolism in the liver [1,2].

Budesonide formulations — Oral and topical budesonide formulations differ in their mode of delivery of the active drug to the intestine. Oral budesonide formulations include [3]:

Controlled ileal release formulation (pH- and time-dependent release) – A coated-capsule preparation facilitates delivery of the medication to the terminal ileum and ascending colon. This formulation contains granules that are coated to protect dissolution in gastric juice but which dissolve at a pH ≥5.5 when the granules reach the duodenum.

pH-dependent release formulation – The pH-dependent release formulation contains enteric-coated pellets with a diameter of 1 mm, coated with an acrylic polymer resistant to a pH <6 that enables its release to the ileum and ascending colon.

               

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Literature review current through: Nov 2016. | This topic last updated: Thu Sep 03 00:00:00 GMT 2015.
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