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Budesonide is a medication used to manage and treat inflammatory diseases, mainly affecting the airways and gastrointestinal tract. It is in the corticosteroid class of medications. This activity reviews the indications, mechanism of action, and contraindications, adverse event profiles, monitoring, and other key elements of budesonide therapy in the clinical setting as relates to the essential points needed by members of an interprofessional team managing the care of the patients with inflammatory diseases, and related conditions. Objectives: Describe the common indications for budesonide therapy. Identify the common budesonide formulations. Describe the most frequently encountered adverse events associated with budesonide therapy. Explain the importance of monitoring for patients on budesonide therapy. Access free multiple choice questions on this topic.

The potential for acute toxicity is rare, but overdosing of budesonide for a prolonged period may result in systemic toxicity such as hypercortisolism. There are not well controlled and adequate clinical trials in pregnant females on budesonide to determine the teratogenic effects on the fetuses. It falls in Pregnancy Category C, and extended-release budesonide should only be used if potential benefits outweigh the harmful effects to the fetus. Both inhaled and intranasal budesonide formulations are rated Pregnancy Category B, which means the drug is safe for use in pregnancy. No data from controlled clinical studies on the use of extended-release budesonide by lactating mothers or their infants at this point, but the potential for serious adverse events in breastfeeding infants is still a consideration. Licensed practitioners and mothers should make a wise decision on whether to discontinue breastfeeding or budesonide ER. The selection of extended-release budesonide treatment requires extreme caution in the geriatric patient population due to reduced hepatic, kidney, or cardiac function, comorbidities, or other concomitant drug therapy. Patients with moderate to severe hepatic disorders require monitoring for manifestations of hypercorticism. Clinical research trials revealed that systemic availability increased 2.5 folds among subjects with cirrhosis compared with healthy subjects, whereas researchers noted no difference in absorption or clearance in either group.

Budesonide is used for various conditions affecting patients of all ages. It is prescribed by interprofessional team members such as physicians of different specialties, physician assistants, and nurse practitioners. The licensed providers must monitor the patients closely for treatment efficacy and systemic toxicity. Besides, they should counsel the patients at each visit, particularly the importance of treatment compliance, and clinicians should emphasize not to stop treatment abruptly. If the patient is using budesonide for asthma, the importance of a rescue inhaler requires explanation. Nurses are the health professionals who see the patients immediately before discharge from the emergency room and floors. Therefore, this presents an excellent opportunity for them to educate the patients and family about budesonide treatment. This counseling must include a strict dietary restriction for grapefruit and abstinence of alcohol, as well as avoiding smoking, flame, and fire during and after administration of rectal foam as it is flammable. As most patients on budesonide treatment are under outpatient management, pharmacists also play a crucial role in the patient treatment management prescribed by the providers. The pharmacists can provide education regarding techniques using new and old inhalers as well as rectal foam administration. Pharmacists should check for symptoms that may reflect potential adverse drug reactions, a drug to drug interactions, or even worsening of the underlying condition due to poor compliance. As the nasal spray is available over the counter also, pharmacists should ensure the patients use it properly. If pharmacists have any concerns, they should immediately communicate with the physicians. The collaboration and cooperation among the interprofessional team members improve the patient’s adherence to treatment regimen and outcome, patient satisfaction, and cost of community health care.