- Budenofalk® capsules containing gastro-resistant granules 3mg (£63.04 = 9mg daily)
- Entocort CR® capsules containing modified-release gastro-resistant granules 3mg (£63.04 = 9mg once daily)
- Rectal foam, one metered application contains 2mg budesonide (£57.11 = 14 application canister)
- Orodispersible tabletsSF 1mg
Indications and dose
- Budenofalk® capsules and Entocort CR® 3mg capsules are included for induction of remission in mild or moderate ileocecal Crohn's disease.
- Budenofalk®: 9mg (three capsules) once daily or 3mg three times daily, for up to 8 weeks; reduce dose for the last 2 weeks of treatment
- Entocort CR®: 9mg (three capsules) once daily in the morning for up to 8 weeks; reduce dose for the last 2–4 weeks of treatment
- Rectal foam is included for active ulcerative colitis affecting the sigmoid colon and rectum
- One metered application once daily for up to 8 weeks
- Orodispersible tabletsSF (hospital only) are included for induction of remission in eosinophilic oesophagitis in line with NICE TA708 (see notes below)
- Prescribe capsules by brand (to prevent confusion where multiple brands contain similar ingredients)
- Treatment with budesonide orodispersible tabletsSF should be initiated by a physician with experience in the diagnosis and treatment of eosinophilic oesophagitis (Summary of Product Characteristics)
- NICE TA708: Budesonide as an orodispersible tabletSF is recommended as an option for inducing remission of eosinophilic oesophagitis (June 2021)
- Rectal solution 20mg in 100ml (£14.95 = 7 enemas)
- Suppositories 5mg (£250.32 = 10 suppositories)
Budesonide prolonged release (Cortiment®)
The routine commissioning of budesonide 9mg prolonged release multi-matrix tablets used for up to 8 weeks treatment is not accepted in Devon for induction of remission in adults with mild to moderate active ulcerative colitis where 5-aminosalicylic acid (5-ASA) treatment is not sufficient (see Commissioning Policy for more details). The policy indicates that in exceptional circumstances the Trust-Managed Individual Patient Treatments process can be used for this indication.
Corticosteroids in Inflammatory Bowel Disease (IBD)
- Before starting steroids consider carefully if symptoms are due to active disease or other diagnosis e.g. co-existing irritable bowel syndrome. A raised CRP may help to confirm active disease.
- Avoid ultra-short or low doses. For the majority of patients start at prednisolone 40mg and decrease over 8 weeks.
- Steroids have no role in maintenance therapy.
- At one year, approximately 50% of patients with ulcerative colitis will be steroid dependent or steroid refractory.
Decision to start immunomodulator therapy for patients with ulcerative colitis will be made by gastroenterologist, typically if:
- More than one course of steroids in any 2 year period
- Following any severe attack requiring IV steroids
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