Budesonide

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Budesonide
Budesonid Grundstruktur V4.svg
Budesonide ball-and-stick.png
Names
Trade namesPulmicort, Rhinocort, Entocort, others
  • 11β,21-Dihydroxy-16α,17α-[butane-1,1-diylbis(oxy)]pregna-1,4-diene-3,20-dione
Clinical data
Drug classCorticosteroid[1]
Main usesAsthma, COPD, nasal polyps, inflammatory bowel disease[2][1][3]
Side effectsInhaled: Respiratory infections, cough, headaches[1]
Pills: Feeling tired, vomiting, joint pains[1]
Pregnancy
category
  • US: B (No risk in non-human studies)
Routes of
use
By mouth, nasal, tracheal, rectal, inhalation
Defined daily dose0.8 mg (inhalation aerosol or powder)
1.5 mg (inhalation solution)[4]
0.2 mg (nasal)[5]
9 mg (by mouth)[6]
External links
AHFS/Drugs.comInhaled: Monograph
Nose: Monograph
US NLMBudesonide
MedlinePlusa608007
Legal
License data
Legal status
  • AU: S2 (Pharmacy medicine)
  • CA: ℞-only
  • UK: POM (Prescription only)
  • US: OTC and Rx-only
Pharmacokinetics
Bioavailability10-20% (first pass effect)
Protein binding85-90%
MetabolismHepatic CYP3A4
Elimination half-life2.0-3.6 hours
ExcretionUrine, feces
Chemical and physical data
FormulaC25H34O6
Molar mass430.541 g·mol−1
3D model (JSmol)
  • CCCC1O[C@@H]2C[C@H]3[C@@H]4CCC5=CC(=O)C=C[C@@]5([C@H]4[C@H](C[C@@]3([C@@]2(O1)C(=O)CO)C)O)C
  • InChI=1S/C25H34O6/c1-4-5-21-30-20-11-17-16-7-6-14-10-15(27)8-9-23(14,2)22(16)18(28)12-24(17,3)25(20,31-21)19(29)13-26/h8-10,16-18,20-22,26,28H,4-7,11-13H2,1-3H3/t16-,17-,18-,20+,21?,22+,23-,24-,25+/m0/s1 ☒N
  • Key:VOVIALXJUBGFJZ-KWVAZRHASA ☒N

Budesonide (BUD), sold under the brand name Pulmicort among others, is a medication of the corticosteroid type.[1] It is available as an inhaler, pill, nasal spray, and rectal forms.[1][2] The inhaled form is used in the long-term management of asthma and chronic obstructive pulmonary disease(COPD).[1][7][8] The nasal spray is used for allergic rhinitis and nasal polyps.[2][9] The pills in a delayed release form and rectal forms may be used for inflammatory bowel disease including Crohn's disease, ulcerative colitis and microscopic colitis.[3][10][11]

Common side effects with the inhaled form include respiratory infections, cough, and headaches.[1] Common side effects with the pills include feeling tired, vomiting, and joint pains.[1] Serious side effects include an increased risk of infection, loss of bone strength, and cataracts.[1] Long-term use of the pill form may cause adrenal insufficiency.[1] Stopping the pills suddenly following long-term use may therefore be dangerous.[1] The inhaled form is generally safe in pregnancy.[1] Budesonide is mainly acting as a glucocorticoid.[1]

Budesonide was initially patented in 1973.[12] Commercial use as an asthma medication began in 1981.[13] It is on the World Health Organization's List of Essential Medicines.[14] Some forms are available as a generic medication.[15] The wholesale price in the developing world for an inhaler containing 200 doses is about US$5 to US$7 as of 2014.[16] As of 2015, the cost for a typical month of the inhaler medication in the United States is US$100 to US$200.[15] In 2019, generic budesonide was listed as involved in Teva's price fixing scheme in the USA.[17] In 2017, it was the 190th most commonly prescribed medication in the United States, with more than three million prescriptions.[18][19]

Medical uses

Asthma

Budesonide is given by metered-dose inhaler or nebulizer for maintenance and prophylactic treatment of asthma including patients who require oral corticosteroids and those who may benefit from a systemic dose reduction.[20]

Inflammatory bowel disease

Formulations of delayed-release budesonide are an effective treatment for mild-to-moderately active Crohn's disease involving the ileum and/or ascending colon.[21] A Cochrane review found evidence for up to three months (but not longer) of maintenance of remission in Crohn's disease.[22]

Budesonide assists in the induction of remission in people with active ulcerative colitis.[23]

Budesonide is highly effective and recommended as the drug of choice in microscopic colitis, for induction and maintenance of remission, and for both the lymphocytic colitis and collagenous colitis forms.[24]

Allergic rhinitis

Budesonide in the form of nasal sprays is a treatment for allergic rhinitis.[25]

Eosinophilic esophagitis

Topical budesonide has considerable effects in eosinophilic esophagitis.[26] For this use, it is formulated as a tablet that disperses in the mouth.[27]

COVID-19

There is tentative evidence that budesonide may be useful in those with mild COVID-19, but at high risk of getting worse.[28] Evidence as of October 2021; however, is insufficient to recommend either for or against its use.[28]

Dosage

The defined daily dose is 0.8 mg (inhalation aerosol) or 800 ucg (inhalation powder) or 1.5 mg (inhalation solution) for asthma[4] and 0.2 mg (nasal) [5] and 9 mg (by mouth).[6]

For COVID a dose of 800 ug twice per day for 2 weeks may be used.[29]

Side effects

Budesonide may cause:[30]

  • Nose irritation or burning
  • Bleeding or sores in the nose
  • Lightheadedness
  • Upset stomach
  • Cough
  • Hoarseness
  • Dry mouth
  • Rash
  • Sore throat
  • Bad taste in mouth
  • Change in mucus
  • Blurred vision [31]

In addition, the following symptoms should be reported immediately:

  • Difficulty breathing or swelling of the face
  • White patches in the throat, mouth, or nose
  • Irregular menstrual periods
  • Severe acne
  • On rare occasions, behavioral changes (mostly affecting children)[30]

Contraindications

Budesonide is contraindicated as a primary treatment of status asthmaticus or other acute episode of asthma where intensive measures are required.[32] It is also contraindicated for patients who have hypersensitivity to budesonide.[33]

Interactions

Those taking tablets or capsules orally should avoid grapefruit juice and echinacea.[medical citation needed]

Also, high-fat meals delay absorption but do not impede absorption.[medical citation needed]

Pharmacology

Budesonide is an agonist of glucocorticoid receptors. Among its effects are:[citation needed]

  • Controls the rate of protein synthesis.
  • Depresses the migration of polymorphonuclear leukocytes and fibroblasts.
  • Reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation.
  • Has a potent glucocorticoid activity and weak mineralocorticoid activity.[medical citation needed]

Pharmacokinetics

  • Onset of action: Nebulization: 2–8 days; Inhalation: 24 hours; Nasal: 10 hours
  • Peak effect: Nebulization: 4–6 weeks; Inhalation: 1–2 weeks
  • Distribution: 2.2-3.9 L/kg
  • Protein binding: 85% to 90%
  • Metabolism: Hepatic via CYP3A4 to two metabolites: 16 alpha-hydroxyprednisolone and 6 beta-hydroxybudesonide; minor activity
  • Bioavailability: Limited by high first-pass effect; Capsule: 9% to 21%; Nebulization: 6%; Inhalation: 6% to 13%
  • Half-life elimination: 2–3.6 hours
  • Time to peak: Capsule: 0.5–10 hours (variable in Crohn's disease); Nebulization: 10–30 minutes; Inhalation: 1–2 hours; Tablet: 7.4-19.2 hours
  • Excretion: urine (60%) and feces as metabolites.[medical citation needed]

Chemistry

Budesonide, also known as 11β,21-dihydroxy-16α,17α-(butylidenebis(oxy))pregna-1,4-diene-3,20-dione, is a synthetic pregnane steroid and non-halogenated cyclic ketal corticosteroid.[34][35] It is the C16α hydroxyl, C16α,17α cyclic ketal with butyraldehyde derivative of prednisolone (11β,17α,21-trihydroxypregna-1,4-diene-3,20-dione).[34][35]

Stereoisomerism

Budesonide
(2 stereoisomers)
(R)-Budesonid
(22R)-configuration
(S)-Budesonid
(22S)-configuration

Society and culture

Cost

The wholesale price in the developing world for an inhaler containing 200 doses is about US$5 to US$7 as of 2014.[16] As of 2015, the cost for a typical month of the inhaler medication in the United States is US$100 to US$200.[15] In 2017, it was the 190th most commonly prescribed medication in the United States, with more than three million prescriptions.[18][19]

Brand names

Inhaler for a powder based in budesonide and formoterol

Aeronide (TH); Aquacort (DE); B Cort (CO); Bronex (PH); Budair (MY); Budecort DP (MY); Budenofalk (DE, GB, HK, KP, PH, SG); Budeson (AR); Budeson Aqua (AR); BudeSpray (TH); Budiair (KP); Budicort Respules (IL); Budinide (KSA); Bunase (TH); Clebudan (CN); Cortiment (GB); Cycortide (HK); Denecort (PH); Duasma (TW); Eltair (MY); Entocort (AR, AT, BE, BR, CH, CZ, DK, FI, FR, GB, HK, IE, IL, IT, KP, NL, NO, PL, PT, SE, TR); Giona Easyhaler (MY, SG, TH); Inflammide (PE); Miflonid (CZ); Miflonide (BE, DE, IL, IT, NZ, PT); Neumocort (PY); Novopulmon (DE, FR); Pulmicon Susp for Nebulizer (KP); Pulmicort (AT, BE, BG, BR, CH, CL, CN, CO, CR, CZ, DE, DK, DO, EE, FI, FR, GB, GR, GT, HN, ID, IN, NI, NL, NO, PA, PK, PL, PT, RU, SE, SV, TR, TW, UY, VE, ZA); Pulmicort Nasal Turbohaler (CL, KE, MU, NG); Pulmicort Turbuhaler (KE, MU, NG); Rafton (FR); Rhinocort (AU); Rhinocort Aqua (HK); Rhinoside (GR); Symbicort (FR, US, ZA) Uceris (US)[citation needed]

See also

References

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External links

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