budesonide

Budesonide is given by metered-dose inhaler or nebulizer for maintenance and prophylactic treatment of asthma, including patients who require oral corticosteroids and those who may benefit from a systemic dose reduction.Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GiNA) 2011. Available at https://www.ginasthma.org {{webarchive|url=https://web.archive.org/web/20131014032230/http://www.ginasthma.org/ |date=14 October 2013}}

Formulations of delayed-release budesonide are an effective treatment for mild-to-moderately active Crohn's disease involving the ileum and/or ascending colon.{{cite journal | vauthors = Lichtenstein GR, Hanauer SB, Sandborn WJ | year = 2009 | title = Management of Crohn's Disease in Adults | journal = Am J Gastroenterol | volume = 104 | issue = 2| pages = 465–83 | pmid = 19174807 | doi=10.1038/ajg.2008.168| s2cid = 10176441| doi-access = free }} A Cochrane review found evidence for up to three months (but not longer) of maintenance of remission in Crohn's disease, concluding that budesonide is not effective for maintenance of remission in CD.{{cite journal | vauthors=Kuenzig ME, Rezaie A, Seow CH, Otley AR, Steinhart AH, Griffiths AM, etal | title=Budesonide for maintenance of remission in Crohn's disease. | journal=Cochrane Database Syst Rev | year=2014 | volume=8 | issue= 8| pages=CD002913 | doi=10.1002/14651858.CD002913.pub3 | pmc=7133546 | pmid=25141071 }}

Budesonide assists in the induction of remission in people with active ulcerative colitis.{{cite journal | vauthors = Habal FM, Huang VW | year = 2012 | title = Review Article: A Decision-Making Algorithm For the Management of Pregnancy in the Inflammatory Bowel Disease Patient | journal = Aliment Pharmacol Ther | volume = 35 | issue = 5| pages = 501–15 | pmid = 22221203 | doi=10.1111/j.1365-2036.2011.04967.x| s2cid = 34662981 | doi-access = free }}

Budesonide is highly effective and recommended as the drug of choice in microscopic colitis, for induction and maintenance of remission, and for both the lymphocytic colitis and collagenous colitis forms.{{cite journal |vauthors=Pardi DS, Tremaine WJ, Carrasco-Labra A |date=January 2016 |title=American Gastroenterological Association Institute Technical Review on the Medical Management of Microscopic Colitis |journal=Gastroenterology |volume=150 |issue=1 |pages=247–274.e11 |doi=10.1053/j.gastro.2015.11.006 |pmid=26584602}}{{cite journal | vauthors = Miehlke S, Guagnozzi D, Zabana Y, Tontini GE, Kanstrup Fiehn AM, Wildt S, Bohr J, Bonderup O, Bouma G, D'Amato M, Heiberg Engel PJ, Fernandez-Banares F, Macaigne G, Hjortswang H, Hultgren-Hörnquist E, Koulaouzidis A, Kupcinskas J, Landolfi S, Latella G, Lucendo A, Lyutakov I, Madisch A, Magro F, Marlicz W, Mihaly E, Munck LK, Ostvik AE, Patai ÁV, Penchev P, Skonieczna-Żydecka K, Verhaegh B, Münch A | title = European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations | journal = United European Gastroenterology Journal | volume = 9 | issue = 1 | pages = 13–37 | date = February 2021 | pmid = 33619914 | pmc = 8259259 | doi = 10.1177/2050640620951905}}

Budesonide in the form of nasal sprays is a treatment for allergic rhinitis.{{cite journal | vauthors = Stanaland BE | title = Once-daily budesonide aqueous nasal spray for allergic rhinitis: a review | journal = Clinical Therapeutics | volume = 26 | issue = 4 | pages = 473–92 | date = April 2004 | pmid = 15189745 | doi = 10.1016/s0149-2918(04)90050-1}}

Topical budesonide has considerable effects in eosinophilic esophagitis.{{cite journal | vauthors = Rawla P, Sunkara T, Thandra KC, Gaduputi V | title = Efficacy and Safety of Budesonide in the Treatment of Eosinophilic Esophagitis: Updated Systematic Review and Meta-Analysis of Randomized and Non-Randomized Studies | journal = Drugs in R&D | volume = 18 | issue = 4 | pages = 259–269 | date = December 2018 | pmid = 30387081 | pmc = 6277325 | doi = 10.1007/s40268-018-0253-9}} For this use, it is formulated as a tablet that disperses in the mouth, and sold under the brand name Jorveza.{{drugs.com|uk|jorveza}}

Budesonide (Tarpeyo (US); Kinpeygo (EU, UK)) is indicated to reduce proteinuria (increased protein levels in the urine) in adults with primary immunoglobulin A (IgA) nephropathy (Berger's disease) at risk of rapid disease progression.{{cite web | title=FDA approves first drug to decrease urine protein in IgA nephropathy, a rare kidney disease | website=U.S. Food and Drug Administration (FDA) | date=17 December 2021 | url=https://www.fda.gov/drugs/fda-approves-first-drug-decrease-urine-protein-iga-nephropathy-rare-kidney-disease | access-date=18 December 2021 | archive-date=19 December 2021 | archive-url=https://web.archive.org/web/20211219081148/https://www.fda.gov/drugs/fda-approves-first-drug-decrease-urine-protein-iga-nephropathy-rare-kidney-disease | url-status=dead }} {{PD-notice}}

Nasal budesonide inhalers have been associated with a number of side effects.{{Cite web|url=https://www.emedicinehealth.com/script/main/notfoundstatic.asp?refurl=/budesonide-nasal_aerosol_inhaler/article.htm|archive-url=https://web.archive.org/web/20081106080137/http://www.emedicinehealth.com/budesonide-nasal_aerosol_inhaler/article.htm|url-status=dead|title=GENERIC NAME: BUDESONIDE - NASAL AEROSOL INHALER (byou-DESS-oh-nide)|archive-date=6 November 2008|website=eMedicineHealth}}{{cite web |title=What are the possible side effects of budesonide nasal (Childrens Rhinocort Allergy, Rhinocort Allergy, Rhinocort Aqua)? |url=https://www.emedicinehealth.com/drug-budesonide_nasal/article_em.htm#sideeffects |website=eMedicineHealth |access-date=25 August 2020 |archive-date=6 August 2020 |archive-url=https://web.archive.org/web/20200806011138/https://www.emedicinehealth.com/drug-budesonide_nasal/article_em.htm#sideeffects |url-status=live }} These include nose irritation or burning, bleeding or sores in the nose, lightheadedness, upset stomach, cough, hoarseness, dry mouth, rash, sore throat, bad taste in mouth, change in mucus, and blurred vision.{{cite web|title=Budesonide: CMDh scientific conclusions and grounds for variation, amendments to the product information and timetable for the implementation - PSUSA/00000449/201604|url=http://www.ema.europa.eu/docs/en_GB/document_library/Periodic_safety_update_single_assessment/2017/03/WC500223322.pdf|publisher=European Medicines Agency (EMA)|access-date=19 May 2017|date=10 March 2017|url-status=live|archive-url=https://web.archive.org/web/20170908174615/http://www.ema.europa.eu/docs/en_GB/document_library/Periodic_safety_update_single_assessment/2017/03/WC500223322.pdf|archive-date=8 September 2017}} Other symptoms which should be reported immediately include difficulty in breathing, swelling of the face, white patches in the throat, mouth, or nose, irregular menstrual periods, severe acne, and on rare occasions, behavioral changes (mostly affecting children).

Acute toxicity from an overdose of budesonide is significantly more rare than an overdosing of budesonide over a prolonged period of therapy, however both can cause systemic toxicity that manifests as hypercortisolism.{{cite book | vauthors = Kalola UK, Ambati S | chapter = Budesonide |date=2024 | title = StatPearls | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK563201/ |access-date=2024-04-28 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=33085348 }} Symptoms of an overdose include more specific symptoms such as darkening and thinning of the skin, changes in body fat around the face, neck, back, and waist, increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex, as well as some less specific symptoms such as diarrhea, dizziness, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.{{Cite web |title=Budesonide (Oral Route) Precautions - Mayo Clinic |url=https://www.mayoclinic.org/drugs-supplements/budesonide-oral-route/precautions/drg-20073233#:~:text=Using%20too%20much%20of%20this,tiredness%20or%20weakness,%20or%20vomiting. |access-date=2024-05-03 |website=www.mayoclinic.org}}{{Cite web |title=Budesonide inhalation Uses, Side Effects & Warnings |url=https://www.drugs.com/mtm/budesonide-inhalation.html |access-date=2024-05-03 |website=Drugs.com |language=en}}

Budesonide is contraindicated in people with:

• Known hypersensitivity to budesonide or any component of the formulation.{{cite journal | vauthors = Todd GR, Acerini CL, Ross-Russell R, Zahra S, Warner JT, McCance D | title = Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom | journal = Archives of Disease in Childhood | volume = 87 | issue = 6 | pages = 457–461 | date = December 2002 | pmid = 12456538 | pmc = 1755820 | doi = 10.1136/adc.87.6.457 }}
• Status asthmaticus or other acute episodes of asthma which would require intensive, immediate measures.{{cite journal |vauthors=Todd GR, Acerini CL, Buck JJ, Murphy NP, Ross-Russell R, Warner JT, McCance DR |year=2002 |title=Acute Adrenal Crisis in Asthmatics Treated With High-Dose Fluticasone Propionate |journal=Eur Respir J |volume=19 |issue=6 |pages=1207–9 |doi=10.1183/09031936.02.00274402 |pmid=12108877 |doi-access=free}}

In Canada, there are additional contraindications labeled for Budesonide for people with:

• Systemic or local bacterial, fungal and viral infections.
• Active or quiescent pulmonary tuberculosis.

Budesonide is mainly metabolized in the liver by the enzyme CYP3A4.{{Cite web |date=April 28, 2024 |title=Budesonide (Oral Inhalation) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}} Drugs that are CYP3A4 inhibitors such as ketoconazole, clarithromycin, ritonavir, and nefazodone, among many others, may inhibit the metabolism of Budesonide, prolonging its elimination and leading to possible increased rates of corticosteroid adverse effects due to unwanted drug accumulation.{{cite journal | vauthors = Ajimura CM, Jagan N, Morrow LE, Malesker MA | title = Drug Interactions With Oral Inhaled Medications | journal = The Journal of Pharmacy Technology | volume = 34 | issue = 6 | pages = 273–280 | date = December 2018 | pmid = 34861014 | pmc = 6231282 | doi = 10.1177/8755122518788809 }} Grapefruit is also a potent inhibitor of CYP3A4, and therefore its consumption is not recommended while on budesonide treatment.{{cite book |title=Handbook of drug-nutrient interactions |vauthors=Baily DG |date=2010 |publisher=Humana Press |isbn=978-1-60327-362-6 |veditors=Boullata JI, Armenti VT |edition=2nd |location=New York, NY |page=282 |chapter=Grapefruit and Other Fruit Juices Interactions with Medicines |chapter-url=https://books.google.com/books?id=6MSRviXlDtAC&pg=PA282}}

{{main|Glucocorticoid#Pharmacology}}

Budesonide is an agonist of glucocorticoid receptors. Among its effects are:

• Controls the rate of protein synthesis.{{cite book |url=https://books.google.com/books?id=eJNNDwAAQBAJ&q=Budesonide+protein+synthesis&pg=160 |title=Saunders Nursing Drug Handbook 2019 E-Book |vauthors=Kizior RJ, Hodgson BB |date=21 February 2018 |publisher=Elsevier Health Sciences |isbn=978-0-323-61257-9 |page=160 |access-date=5 October 2020 |archive-url=https://web.archive.org/web/20240430044452/https://books.google.com/books?id=eJNNDwAAQBAJ&q=Budesonide+protein+synthesis&pg=160#v=snippet&q=Budesonide%20protein%20synthesis&f=false |archive-date=30 April 2024 |url-status=live}}
• Depresses the migration of polymorphonuclear leukocytes and fibroblasts.{{cite book |url=https://books.google.com/books?id=iS_wDwAAQBAJ&q=Budesonide+fibroblasts+migration&pg=187 |title=Mosby's Canadian Nursing Drug Reference - E-Book |vauthors=Skidmore-Roth L, Richardson F |date=9 July 2020 |publisher=Elsevier Health Sciences |isbn=978-1-77172-084-7 |page=187 |access-date=5 October 2020 |archive-url=https://web.archive.org/web/20240311071449/https://books.google.com/books?id=iS_wDwAAQBAJ&q=Budesonide+fibroblasts+migration&pg=187#v=snippet&q=Budesonide%20fibroblasts%20migration&f=false |archive-date=11 March 2024 |url-status=live}}
• Reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation.
• Has a potent glucocorticoid activity and weak mineralocorticoid activity.{{cite book | vauthors = Gavins F, Flower RJ | chapter = Budesonide |date= January 2008 | title = xPharm: The Comprehensive Pharmacology Reference |pages=1–5 | veditors = Enna SJ, Bylund DB | chapter-url=https://www.sciencedirect.com/science/article/pii/B9780080552323613509 |access-date=2024-05-03 |place=New York |publisher=Elsevier | doi = 10.1016/B978-008055232-3.61350-9 |isbn=978-0-08-055232-3 }}

Different pharmacokinetic proprieties can be seen in the absorption of budesonide depending on how it is formulated. When taken as an extended-release oral capsule, budesonide has an oral bioavailability of 9–21% and reaches peak plasma concentrations (C_max) within 2–8 hours.{{Cite web |date=April 28, 2024 |title=Budesonide (Systemic) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}} A high fat meal when taken with the capsule can lengthen the time it takes to reach C_max by another 2.3 hours, but will not have any other affects on the pharmacokinetics properties of budesonide.{{Cite web |title=Budesonide |url=https://go.drugbank.com/drugs/DB01222 |access-date=2024-04-28 |website=go.drugbank.com |language=en}} When inhaled through an metered dose inhaler, 34% of budesonide is deposited in the lung with a bioavailability of 39% and reaches C_max within 10 minutes.{{Cite web |date=April 28, 2024 |title=Budesonide (Oral Inhalation) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}} When nebulized, budesonide has an bioavailability of 6% and reaches C_max within 1–3 hours. When formulated as a rectal foam, budesonide has an bioavailability of 3% to 27% and reaches C_max around 1.5 hours.{{Cite web |date=April 28, 2024 |title=Budesonide (Topical) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}}

The plasma protein binding of budesonide is around 85-90%, with an apparent volume of distribution of 2.2-3.9L/kg. Budesonide is 80-90% metabolized at first pass in the liver by the hepatocytic cytochrome P450 isoenzyme 3A4 (CYP3A4) into two metabolites: 16 alpha-hydroxyprednisolone and 6 beta-hydroxybudesonide. Both of these metabolites have a negligible glucocorticoid activity of less than 1% compared to the parent compound budesonide. 60% of budesonide is excreted is through the urine as its metabolites, no unchanged budesonide is detectable in urine. The average elimination half-life in plasma is between 2-3.6 hours.

{{See also|List of corticosteroids|List of corticosteroid cyclic ketals}}

Budesonide, also known as 11β,21-dihydroxy-16α,17α-(butylidenebis(oxy))pregna-1,4-diene-3,20-dione, is a synthetic pregnane steroid and non-halogenated cyclic ketal corticosteroid.{{cite book| vauthors = Elks J |title=The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies|url=https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA186|date=14 November 2014|publisher=Springer|isbn=978-1-4757-2085-3|pages=186, 1011|url-status=live|archive-url=https://web.archive.org/web/20170908174614/https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA186|archive-date=8 September 2017}}{{cite book| vauthors = Lemke TL, Williams DA |title=Foye's Principles of Medicinal Chemistry|url=https://books.google.com/books?id=R0W1ErpsQpkC&pg=PA1253|year=2008|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-6879-5|pages=1253–|url-status=live|archive-url=https://web.archive.org/web/20170908174614/https://books.google.com/books?id=R0W1ErpsQpkC&pg=PA1253|archive-date=8 September 2017}} It is the C16α hydroxyl, C16α,17α cyclic ketal with butyraldehyde derivative of prednisolone (11β,17α,21-trihydroxypregna-1,4-diene-3,20-dione).

File:Budesonide and formoterol inhaler.jpg.]]

Budesonide is marketed under various brand and generic names internationally. Notable examples for each formulation include:

Inhalation: Pulmicort, Pulmicort Flexhaler, Pulmicort Nebuamp, Pulmicort Turbuhaler, TARO-Budesonide, TEVA-Budesonide, Novolizer budesonid meda, Budenova.{{Cite web |date=April 28, 2024 |title=Budesonide (Oral Inhalation) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}}{{Cite web |title=Budesonide |url=https://go.drugbank.com/drugs/DB01222 |access-date=2024-04-28 |website=go.drugbank.com |language=en}}

Systemic (oral pills): Tarpeyo, Uceris, Eohilia, Cortiment, Entocort Jorveza.{{Cite web |date=April 28, 2024 |title=Budesonide (Systemic) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}}

Nasal: MYLAN-Budesonide AQ, Rhinocort Aqua, Formancis.{{Cite web |date=April 28, 2024 |title=Budesonide (Nasal) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}}

Topical: Entocort, Uceris, Budenofalk.{{Cite web |date=April 28, 2024 |title=Budesonide (Topical) |url=https://online.lexi.com |website=Lexi-Drugs |series=UpToDate Lexidrug. |publisher=UpToDate Inc.}}

In 2019, 44 US states filed a lawsuit claiming that leading drug companies including Teva, Pfizer, Novartis and Mylan conspired to inflate the prices of over a hundred generic drugs, including budesonide, as much as tenfold.{{Cite news|vauthors=Murphy H|date=11 May 2019|title=Teva and Other Generic Drugmakers Inflated Prices Up to 1,000%, State Prosecutors Say|work=The New York Times|url=https://www.nytimes.com/2019/05/11/health/teva-price-fixing-lawsuit.html|url-status=live|url-access=registration|access-date=27 May 2020|archive-date=30 May 2020|archive-url=https://web.archive.org/web/20200530154338/https://www.nytimes.com/2019/05/11/health/teva-price-fixing-lawsuit.html}}

Kinpeygo, a hybrid medicine of Entocort (which has been authorised in the EU since 2 April 1992) that contains the same active substance as Entocort but has a different formulation and a different indication,{{cite web | title=Kinpeygo: Pending EC decision | website=European Medicines Agency (EMA) | date=20 May 2022 | url=https://www.ema.europa.eu/en/medicines/human/summaries-opinion/kinpeygo | access-date=20 May 2022 | archive-date=20 May 2022 | archive-url=https://web.archive.org/web/20220520151855/https://www.ema.europa.eu/en/medicines/human/summaries-opinion/kinpeygo | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged. was approved for medical use in the European Union in July 2022.{{cite web | title=Kinpeygo EPAR | publisher=European Medicines Agency (EMA) | date=17 May 2022 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/kinpeygo| archive-date=4 March 2023 | archive-url=https://web.archive.org/web/20230304065605/https://www.ema.europa.eu/en/medicines/human/EPAR/kinpeygo | url-status=live }}{{cite web | title=Kinpeygo Product information|id=EU/1/22/1657| website=Union Register of medicinal products | url=https://ec.europa.eu/health/documents/community-register/html/h1657.htm | access-date=3 March 2023 | archive-date=4 March 2023 | archive-url=https://web.archive.org/web/20230304065613/https://ec.europa.eu/health/documents/community-register/html/h1657.htm | url-status=live }} With cumulative list of related EU decisions.

The FDA granted the application breakthrough therapy designation.{{cite web | title=CY 2024 CDER Breakthrough Therapy Calendar Year Approvals | url=https://www.fda.gov/media/97001/download | archive-url=https://web.archive.org/web/20190807103314/https://www.fda.gov/media/97001/download | url-status=dead | archive-date=7 August 2019 | format=PDF | publisher=U.S. Food and Drug Administration (FDA) | date=September 30, 2024 }}

Budesonide was recommended in April 2021 by the UK's NHS to treat COVID-19 on a case-by-case basis for those aged 50 years of age and older.{{cite web |title=COVID-19 Therapeutic Alert - Inhaled Budesonide for Adults (50 Years and Over) with COVID-19 |url=https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103154 |website=Central Alerting System |date=12 April 2021 |access-date=16 April 2021 |archive-date=12 April 2021 |archive-url=https://web.archive.org/web/20210412150959/https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103154 |url-status=live }} After a University of Oxford research team found in a trial with 1,700 patients that budesonide could benefit many people over 50 with COVID-19 symptoms, it was recommended from 12 April 2021, by the National Health Service in the UK for general practitioners (GPs) to treat COVID-19 on a case-by-case basis.{{Cite news |title=Covid: Asthma drug 'speeds up recovery at home' |vauthors=Roxby P |website=BBC News |date=12 April 2021 |url=https://www.bbc.co.uk/news/health-56717486 |access-date=12 April 2021 |archive-date=12 April 2021 |archive-url=https://web.archive.org/web/20210412184831/https://www.bbc.co.uk/news/health-56717486 |url-status=live }}{{Cite news|vauthors=Blakely R|title=Asthma drug Budesonide speeds up Covid recovery times|url=https://www.thetimes.com/uk/healthcare/article/asthma-drug-speeds-up-covid-recovery-times-t0630b7lp|newspaper=The Times|date=12 April 2021|url-access=subscription|issn=0140-0460|access-date=13 April 2021|archive-date=6 November 2021|archive-url=https://web.archive.org/web/20211106022706/https://www.thetimes.co.uk/article/asthma-drug-speeds-up-covid-recovery-times-t0630b7lp|url-status=live}} Results of a large-scale trial published in August 2021 suggest that inhaled budesonide improves the time of recovery and people's well-being during the recovery process.{{Cite journal |title=Platform trial rules out treatments for COVID-19 |url=https://evidence.nihr.ac.uk/alert/platform-trial-rules-out-covid-treatments/ |journal=NIHR Evidence |date=31 May 2022 |doi=10.3310/nihrevidence_50873 |type=Plain English summary |access-date=1 June 2022 |archive-date=1 June 2022 |archive-url=https://web.archive.org/web/20220601095141/https://evidence.nihr.ac.uk/alert/platform-trial-rules-out-covid-treatments/ |url-status=live |url-access=subscription }}{{cite journal | vauthors = Yu LM, Bafadhel M, Dorward J, Hayward G, Saville BR, Gbinigie O, Van Hecke O, Ogburn E, Evans PH, Thomas NP, Patel MG, Richards D, Berry N, Detry MA, Saunders C, Fitzgerald M, Harris V, Shanyinde M, de Lusignan S, Andersson MI, Barnes PJ, Russell RE, Nicolau DV, Ramakrishnan S, Hobbs FD, Butler CC | title = Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial | journal = Lancet | volume = 398 | issue = 10303 | pages = 843–855 | date = September 2021 | pmid = 34388395 | pmc = 8354567 | doi = 10.1016/S0140-6736(21)01744-X }} Inhalational budesonide was added to the recommended treatment for cases of COVID-19 in India in April 2021.{{cite news|date=29 April 2021|title=New guidelines prescribe inhaled steroid 'Budesonide', antiparasitic drug 'Ivermectin' for mild Covid cases|url=https://www.newindianexpress.com/nation/2021/apr/29/new-guidelines-prescribe-inhaled-steroid-budesonide-antiparasitic-drug-ivermectin-for-mild-covid-cases-2296446.html|website=The New Indian Express|access-date=11 July 2021|archive-date=6 November 2021|archive-url=https://web.archive.org/web/20211106022707/https://www.newindianexpress.com/nation/2021/apr/29/new-guidelines-prescribe-inhaled-steroid-budesonide-antiparasitic-drug-ivermectin-for-mild-covid-cases-2296446.html|url-status=live}}{{Cite web|date=24 May 2021|title=Clinical Management Protocol for Covid-19 (in Adults)|url=https://www.mohfw.gov.in/pdf/UpdatedDetailedClinicalManagementProtocolforCOVID19adultsdated24052021.pdf|website=Ministry of Health and Family Welfare (India)|access-date=10 July 2021|archive-date=5 December 2021|archive-url=https://web.archive.org/web/20211205052720/https://www.mohfw.gov.in/pdf/UpdatedDetailedClinicalManagementProtocolforCOVID19adultsdated24052021.pdf|url-status=live}} The NIH recommendation was withdrawn in December 2021 citing the need for more research.{{Cite web |vauthors=Burns C |title=NICE removes budesonide from recommended COVID-19 treatments |url=https://pharmaceutical-journal.com/article/news/nice-removes-budesonide-from-recommended-covid-treatments |access-date=1 June 2022 |website=The Pharmaceutical Journal |date=15 December 2021 |archive-date=26 June 2022 |archive-url=https://web.archive.org/web/20220626033349/https://pharmaceutical-journal.com/article/news/nice-removes-budesonide-from-recommended-covid-treatments |url-status=live }}{{cite web | title=Withdrawal of the Recommendation for Consideration of Inhaled Budesonide as a Treatment Option for COVID-19 | website=Central Alerting System | url=https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103185 | access-date=20 May 2022 | archive-date=30 June 2022 | archive-url=https://web.archive.org/web/20220630023652/https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103185 | url-status=live }}

{{Reflist}}

• {{cite web | title=Budesonide Nasal Spray | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a601030.html }}
• {{cite web | title=Budesonide Oral Inhalation | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a699056.html }}

{{Glucocorticoids}}

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Category:Aldols

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Category:Pregnanes

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