Budesonide

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Budesonide
Budesonid Grundstruktur V4.svg
Budesonide ball-and-stick.png
Clinical data
Trade namesPulmicort, Rhinocort, Entocort, others
Other namesBUD
AHFS/Drugs.comMonograph
MedlinePlusa608007
License data
Pregnancy
category
  • AU: A / B3
Routes of
administration		By mouth, nasal, tracheal, rectal, inhalation
ATC code
Legal status
Legal status
  • AU: S2 (Pharmacy medicine) / S4
  • CA: ℞-only
  • UK: POM (Prescription only)
  • US: OTC / Rx-only
  • EU: Rx-only
Pharmacokinetic data
Bioavailability10-20% (first pass effect)
Protein binding85-90%
MetabolismLiver CYP3A4
Elimination half-life2.0-3.6 hours
ExcretionUrine, feces
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
PDB ligand
CompTox Dashboard (EPA)
ECHA InfoCard100.051.927 Edit this at Wikidata
Chemical and physical data
FormulaC25H34O6
Molar mass430.541 g·mol−1
3D model (JSmol)
SMILES
InChI
 ☒NcheckY (what is this?)  

Budesonide (BUD), sold under the brand name Pulmicort among others, is a medication of the corticosteroid type.[1] It is available as an inhaler, nebulization solution, 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][3][4] The nasal spray is used for allergic rhinitis and nasal polyps.[2][5] 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.[6][7][8] Budesonide was approved in April 2021 by the UK's NHS to treat COVID-19 on a case-by-case basis.[9]

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 chiefly acts as a glucocorticoid.[1]

Budesonide was initially patented in 1973.[10] Commercial use as an asthma medication began in 1981.[11] It is on the World Health Organization's List of Essential Medicines.[12] Some forms are available as a generic medication.[13] In 2019, generic budesonide was listed as involved in Teva's price fixing scheme in the United States.[14] In 2018, it was the 180th most commonly prescribed medication in the United States, with more than 3 million prescriptions.[15][16]

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.[17]

COVID-19[]

After a University of Oxford research team found in a trial with 1,700 patients that budesonide could benefit many people over 50 with COVID-19 symptoms, it was approved from 12 April 2021 by the National Health Service in the UK for general practitioners (GPs) to treat Covid on a case-by-case basis. Final results of the trial are expected in late April.[18][19]

Inhalational Budesonide has been part of the recommended treatment for mild covid cases in India since April 2021.[20][21]

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.[22] A Cochrane review found evidence for up to three months (but not longer) of maintenance of remission in Crohn's disease.[23]

Budesonide assists in the induction of remission in people with active ulcerative colitis.[24]

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.[7]

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, and sold under the trade name Jorveza.[27]

Side effects[]

Nasal budesonide inhalers have been associated with a number of side effects.[28][29] These include 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, and blurred vision.[30] Other symptoms which should be reported immediately include difficulty in breathing, swelling of the face, white patches in the throat, mouth, or nose, irregular menstrual periods, severe acne, and on rare occasions, behavioral changes (mostly affecting children)[28]

Contraindications[]

Budesonide is contraindicated as a primary treatment of status asthmaticus or other acute episode of asthma where intensive measures are required.[31] It is also contraindicated for patients who have hypersensitivity to budesonide.[32]

Interactions[]

Those taking tablets or capsules orally should avoid grapefruit and grapefruit juice[33][34] and echinacea.[35]: 160 

  • Grapefruit juice may double bioavailability of oral budesonide.[medical citation needed]
  • Echinacea diminishes bioavailability.[medical citation needed]

Also, high-fat meals delay absorption but do not impede absorption.[36]

Pharmacology[]

Budesonide is an agonist of glucocorticoid receptors. Among its effects are:

  • Controls the rate of protein synthesis.[37]
  • Depresses the migration of polymorphonuclear leukocytes and fibroblasts.[38]
  • 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: and ; 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[]

See also: List of corticosteroids and List of corticosteroid cyclic ketals

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.[39][40] It is the C16α hydroxyl, C16α,17α cyclic ketal with butyraldehyde derivative of prednisolone (11β,17α,21-trihydroxypregna-1,4-diene-3,20-dione).[39][40]

Stereoisomerism[]

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

Society and culture[]

Brand names[]

Inhaler for a powder based on 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);[35]: 13  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);[35]: 13  Pulmicort Nasal Turbohaler (CL, KE, MU, NG); Pulmicort Turbuhaler (KE, MU, NG); Rafton (FR); Rhinocort (AU); Rhinocort Aqua (HK);[41] Rhinoside (GR); Symbicort (FR, US, ZA) Uceris (US).

References[]

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