Budesonide rectal preparation in the US

deltaforce said...
Reading an article about Osteoporosis in corticosteroid users. I have used only Prednisone and Hydrocortisone for my ulcerative colitis, never Budesonide. This guy has a very little systemic activity so its far better than its cousins.

I have never heard this one in the US. Just curious if I lack the knowledge or its indeed not available in the US as a rectal preparation?

Thanks in advance.

(If its not available in the US and anybody participated in a clinical trial or have used it, comment is welcome about its efficacy, in reducing / controlling the flare and its systemic effects like weight gain and mood swings. Osteoporosis is rather a long shot, compared to weight gain and mood swings.)

I use Mesalamine/Budesonide enema. It is helping me. I also use Entocort capsules too. I do not notice the systemic effects with these as with Prednisone.
Also, with respect to the capsules, I feel that Brand name Entocort helps me more compared to generic Budesonide. Entocort is around twice the cost of Budesonide.
I do not know if my enema has Budesonide or Entocort in it, so I cannot compare them with respect to enema.

You can refer to www.healingwell.com/community/default.aspx?f=38&m=2487681 for a similar discussion where I responded with the compounding pharmacy that I use:
“My GI at John Hopkins referred me, if I remember correctly, to Kaye's Pharmacy (http://www.kayesepicpharmacy.com) for my Mesalamine/Entocort enemas. But when Kaye's Pharmacy did not accept my insurance, GI referred me to Northern Pharmacy (http://www.northernpharmacy.com/). I have ordered my enemas twice from Northern Pharmacy, and the service was good - Shipment was well packed, and was received in couple of days of ordering.”

deltaforce said...
Thanks for the reply.

Could you please elaborate me on dosing and tapering with Budesonide.
Do you taper the same way as Prednisone?
Since you have used Prednisone as well, how would you compare efficacy of Budesonide in controlling your flare?
What was your Prednisone starting dose when you started on it? 40mg or higher? And what is your Budesonide starting dose? (just for comparison purpose).

How often do you use Mesalamine/Budesonide enemas? I presume that your enema contains generic Budesonide.

Deltaforce,

Sorry for the delay in responding.

Entocort/Budosonide dosage for me started with 9mg (3*3mg), and I have been asked to taper it. Depending on how we feel while tapering, we can do few days of alternating 9mg and 6mg before going to 6mg, or we can just go to 6mg from 9mg. Similarly, we can continue the rest of the tapering to zilch.

My predisone starting dose was 40mg.

Enema was Mesalamine 4gm and Budesonide 2mg. I started with 1 enema/day, and I think it is good to taper it too before stopping.

As mentioned by kazbern in the other thread of yours, Entocort/Budosonide oral is mostly for the ascending/right colon. And enema, as you might already know, would be for descending/left colon.

Entocort/Budosonide is not as effective as Prednisone in controlling the symptoms or flare, but it was helpful. It cleared most of the inflammation in ascending/right colon. But with Entocort/Budosonide I do not see the systemic side effects like Moon face, weight gain, sleeplessness, etc., (in addition to a positive side effect of clearing my Psoriasis) which are common with Prednisone. So even if the Entocort/Budosonide is not as helpful as Prednisone in controlling UC symptoms, I am more comfortable with Entocort/Budosonide than with Prednisone.

Let me know if you have any other questions on this topic.

Added later: When I was in midst of an horrible flare, my GI suggested that I start with Prednisone 40mg. And he wanted me to start Entocort oral 9mg, only after I tapered Prednisone to 20mg.

Ive never heard of rectal budesonide for AIH, but I suppose what little budesonide does get absorbed would go straight to the liver.

What exactly is your question though, just whether there is another way to take it? There is oral budesonide, but the method of administration wont change the side effects you get.