Understanding Budesonide: Side Effects & Usage

Budesonide is a corticosteroid medication that plays a crucial role in managing a range of inflammatory conditions. While highly effective, like all medicines, it can present a spectrum of side effects. Understanding these potential reactions is vital for patients to use budesonide safely and effectively. This article delves into the various aspects of budesonide, from its uses to its potential side effects, offering guidance for both inhaler and capsule forms.

What is Budesonide Used For?

Budesonide is primarily prescribed to reduce inflammation. Its applications are diverse:

• Asthma and COPD: It is commonly found in inhalers to manage respiratory conditions like asthma and Chronic Obstructive Pulmonary Disease (COPD). When inhaled, very little of the medicine enters the rest of the body, making systemic side effects less likely.
• Crohn's Disease: Budesonide 3 mg prolonged-release capsules are used to treat inflammation in the small and large intestines, particularly during flare-ups of Crohn's disease.
• Microscopic Colitis: These capsules are also prescribed for microscopic colitis, a condition characterised by chronic inflammation of the large bowel leading to watery diarrhoea.
• Other Inflammatory Conditions: A brand of budesonide, Budenofalk®, is also indicated for autoimmune hepatitis (a type of chronic liver inflammation) and to reduce diarrhoea associated with collagenous colitis.

Potential Side Effects of Budesonide Inhalers

When budesonide is used via an inhaler, the risk of experiencing side effects is generally lower because the medication is delivered directly to the lungs, with minimal absorption into the bloodstream. However, some side effects can still occur:

Common Side Effects (More than 1 in 100 people):

• Oral Thrush: This is a fungal infection causing white patches, redness, and soreness in the mouth. To minimise this risk, it is recommended to rinse your mouth with water or brush your teeth after using the inhaler. If oral thrush develops, consult a pharmacist for suitable antifungal treatments like mouth gel, while continuing to use your budesonide inhaler.
• Dry or Sore Throat, Hoarse Voice: Similar to oral thrush, rinsing your mouth with water or brushing your teeth after inhalation can help. If these symptoms persist or are bothersome, seek advice from your doctor, nurse, or pharmacist. They can also check if you are using your inhaler correctly.

Serious Side Effects (Uncommon with Inhalers):

Serious side effects are unusual with budesonide inhalers, but the risk increases with higher doses and prolonged use (over several months).

• Adrenal Insufficiency: If you are on high doses of budesonide, or taking it with other steroid medicines or certain antifungal or HIV medications, you may develop underactive adrenal glands. Symptoms can include extreme tiredness, mood changes, loss of appetite, weight loss, and feeling very dizzy. In such cases, carrying a red steroid emergency card might be advised by your doctor.
• Cushing's Syndrome: Signs include a puffy, rounded face ("moon face") and weight gain in the upper back or abdomen. This is a gradual development and warrants a discussion with your doctor.
• Infections: Symptoms like high temperature, chills, sore throat, cough, or a wound that won't heal can indicate an infection, requiring immediate medical attention.
• Eye Problems: Changes in eyesight, such as blurred vision or cloudy lenses, can be signs of increased eye pressure (glaucoma) or cataracts.

Serious Allergic Reaction (Anaphylaxis):

In rare instances, budesonide inhalers can trigger a severe allergic reaction. Immediate medical attention (call 999) is required if you experience:

• Sudden swelling of the lips, mouth, throat, or tongue.
• Difficulty breathing, wheezing, or a choking sensation.
• Tightness in the throat or difficulty swallowing.
• A blue, grey, or pale discolouration of the skin, tongue, or lips (easier to observe on lighter skin tones).
• Sudden confusion, drowsiness, or dizziness.
• Fainting or unresponsiveness.
• Lethargy or unresponsiveness in a child.

A swollen, itchy, blistered, or peeling rash can also accompany a serious allergic reaction.

Long-Term Side Effects

Children and Teenagers:

Prolonged use of budesonide inhalers at higher doses may potentially slow down growth in children and teenagers. However, this risk is very low (less than 1 in 10,000). Doctors and asthma nurses closely monitor the height and weight of children using budesonide to detect any growth slowing and adjust treatment if necessary. Even if growth slows temporarily, it typically has minimal impact on final adult height. The aim is always to use the lowest effective steroid dose.

Adults:

If used as directed, lasting side effects in adults are uncommon. However, adults on high doses (inhaler or nebuliser) may have an increased risk of adrenal gland problems or weakened bones (osteoporosis) over time due to increased steroid absorption. Regular monitoring and potentially bone-strengthening medications, along with a calcium-rich diet and exercise, are recommended.

Potential Side Effects of Budesonide Capsules

Budesonide capsules, particularly the prolonged-release versions for Crohn's disease and microscopic colitis, can have a broader range of side effects as more of the medication enters the systemic circulation.

Common Side Effects (May affect up to 1 in 10 people):

• Heartburn
• Muscle cramps
• Palpitations (pounding heart beat)
• Rash or itchy skin
• Heavy or irregular periods in women
• Low potassium levels (leading to muscle weakness, thirst, or pins and needles)
• Cushingoid features (rounded face, acne, weight gain, easy bruising)
• Behavioural changes (nervousness, difficulty sleeping, mood swings, depression)

Uncommon Side Effects (May affect up to 1 in 100 people):

• Shaking
• Restlessness or involuntary movements
• Anxiety

Rare Side Effects (May affect up to 1 in 1000 people):

• Aggression
• Clouding of the eye's lens
• Skin discolouration from bleeding beneath the skin
• Glaucoma (increased eye pressure)
• Blurred vision

Very Rare Side Effects (May affect up to 1 in 10,000 people):

• Severe allergic reactions (anaphylaxis)
• Slowing of growth rate in children and adolescents

Other potential long-term effects of corticosteroid use include changes in bone mineral density (thinning of the bones) and effects on the adrenal glands. Mental health issues, such as depression or suicidal thoughts, can occur, particularly with high doses over long periods. It is crucial to discuss any mental health changes with your doctor.

Important Considerations and Interactions

Medicines Affecting Budesonide:

Certain medications can influence how budesonide works:

• Steroid Medicines (e.g., prednisolone, dexamethasone): Taking other steroids concurrently can increase the risk of side effects.
• Colestyramine: Used for cholesterol or itching, it can affect budesonide absorption.
• Ketoconazole, Itraconazole: Antifungal medications can increase budesonide levels.
• Oestrogen-containing Medicines (e.g., HRT, some contraceptives): May increase budesonide effects.
• HIV Protease Inhibitors (e.g., ritonavir, cobicistat): Can significantly increase budesonide levels and the risk of side effects.
• Carbamazepine: Used for epilepsy, it may affect budesonide.
• Grapefruit Juice: Should be avoided as it can interfere with budesonide's effectiveness.

Diagnostic tests for pituitary gland function may show falsely low values when taking budesonide due to its effect on adrenal function.

When Not to Take Budesonide Capsules:

• Allergy to budesonide or other ingredients.
• Active infection.

Precautions and Warnings:

Consult your doctor before taking budesonide capsules if you have a history of:

• Tuberculosis (TB)
• High blood pressure
• Diabetes
• Osteoporosis (brittle bones)
• Stomach ulcers
• Glaucoma or cataracts
• Liver problems
• Mental health issues (or a family history)

Inform your doctor about any visual disturbances, such as blurred vision.

Dosage and Administration

Always follow your doctor's or pharmacist's instructions regarding dosage and administration. Budesonide capsules should be swallowed whole with water and not chewed or crushed.

Crohn's Disease:

Typically, 3 capsules are taken in the morning before breakfast for up to 8 weeks, with the dose gradually reduced thereafter. Full effect is usually seen within 2-4 weeks.

Microscopic Colitis:

• Active Disease: 3 capsules once daily in the morning.
• Maintenance of Remission: 2 capsules once daily in the morning, or the lowest effective dose.

Dose reduction is usually necessary when discontinuing treatment.

Frequently Asked Questions

Q1: Can budesonide cause mood changes?

Yes, behavioural changes such as feeling nervous, difficulty sleeping, mood swings, and depression can occur, particularly with capsules. If you experience any mood changes, discuss them with your doctor.

Q2: Is it safe to take budesonide long-term?

While budesonide is effective for chronic conditions, long-term use, especially at high doses, can increase the risk of certain side effects like adrenal insufficiency, osteoporosis, and Cushing's syndrome. Your doctor will monitor you closely and aim for the lowest effective dose.

Q3: What should I do if I miss a dose?

If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one.

Q4: Can children take budesonide?

Yes, budesonide inhalers are commonly used in children for asthma. While there's a small risk of growth slowing with long-term high-dose use, this is closely monitored by healthcare professionals.

Q5: Are there any foods or drinks to avoid with budesonide?

Yes, grapefruit juice should be avoided as it can affect how budesonide works. Ensure your diet is rich in calcium and consider regular exercise to support bone health, especially with long-term use.

This information is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.