Budesonide (compounded oral)

Also known as: corticosteroid, oral viscous budesonide (OVB), budesonide oral suspension (BOS)

Other

In plain English

Budesonide is a corticosteroid designed to act mainly where it's needed with less whole-body steroid effect because much of it is cleared by the liver on first pass. It's used for inflammatory gut conditions (such as certain forms of Crohn's/colitis and eosinophilic esophagitis, where a swallowed form coats the esophagus) and for airway inflammation in other formulations. Long or high-dose use can still cause steroid side effects.

The science

Budesonide is a high-potency glucocorticoid with extensive first-pass hepatic metabolism (~90%), giving strong local anti-inflammatory activity in the gut/airway with reduced systemic corticosteroid exposure. Randomized, placebo-controlled trials show oral viscous/suspension budesonide induces histologic and symptomatic remission in eosinophilic esophagitis (e.g., a phase 3 trial of budesonide oral suspension 2 mg twice daily was superior to placebo), and it is used for ileocecal Crohn's and microscopic colitis.

References

• Dohil R et al., oral viscous budesonide in pediatric eosinophilic esophagitis (RCT), Gastroenterology 2010
• Hirano I et al., budesonide oral suspension in eosinophilic esophagitis (phase 3 trial), Clin Gastroenterol Hepatol 2022