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Budesonide
Also known as: Pulmicort, Entocort, Rhinocort, 51333-22-3, Preferid, Rhinocort aqua
Molecular Formula
C25H34O6
Molecular Weight
430.5  g/mol
InChI Key
VOVIALXJUBGFJZ-KWVAZRHASA-N
FDA UNII
Q3OKS62Q6X

A glucocorticoid used in the management of ASTHMA, the treatment of various skin disorders, and allergic RHINITIS.
Budesonide is a Corticosteroid. The mechanism of action of budesonide is as a Corticosteroid Hormone Receptor Agonist.
1 2D Structure

Budesonide

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
(1S,2S,4R,8S,9S,11S,12S,13R)-11-hydroxy-8-(2-hydroxyacetyl)-9,13-dimethyl-6-propyl-5,7-dioxapentacyclo[10.8.0.02,9.04,8.013,18]icosa-14,17-dien-16-one
2.1.2 InChI
InChI=1S/C25H34O6/c1-4-5-21-30-20-11-17-16-7-6-14-10-15(27)8-9-23(14,2)22(16)18(28)12-24(17,3)25(20,31-21)19(29)13-26/h8-10,16-18,20-22,26,28H,4-7,11-13H2,1-3H3/t16-,17-,18-,20+,21?,22+,23-,24-,25+/m0/s1
2.1.3 InChI Key
VOVIALXJUBGFJZ-KWVAZRHASA-N
2.1.4 Canonical SMILES
CCCC1OC2CC3C4CCC5=CC(=O)C=CC5(C4C(CC3(C2(O1)C(=O)CO)C)O)C
2.1.5 Isomeric SMILES
CCCC1O[C@@H]2C[C@H]3[C@@H]4CCC5=CC(=O)C=C[C@@]5([C@H]4[C@H](C[C@@]3([C@@]2(O1)C(=O)CO)C)O)C
2.2 Other Identifiers
2.2.1 UNII
Q3OKS62Q6X
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Budesonide, (r)-isomer

2. Budesonide, (s)-isomer

3. Horacort

4. Pulmicort

5. Rhinocort

6. Tarpeyo

2.3.2 Depositor-Supplied Synonyms

1. Pulmicort

2. Entocort

3. Rhinocort

4. 51333-22-3

5. Preferid

6. Rhinocort Aqua

7. Entocort Ec

8. Uceris

9. Pulmicort Respules

10. Respules

11. Budeson

12. Pulmicort Flexhaler

13. Cortivent

14. Micronyl

15. Spirocort

16. Bidien

17. S-1320

18. Map-0010

19. Chebi:3207

20. Q3oks62q6x

21. 51372-29-3

22. Mls000028507

23. Budesonide Mmx

24. Budesonidum

25. Rhinocort Alpha

26. Map0010

27. R01ad05

28. (11beta,16alpha)-16,17-(butylidenebis(oxy))-11,21-dihydroxypregna-1,4-diene-3,20-dione

29. 16a(r),17-(butylidenebis(oxy))-11b,21-dihydroxypregna-1,4-diene-3,20-dione

30. Nsc-757788

31. Budenofalk

32. Budesonido

33. Smr000058337

34. Budecort Inhaler

35. Budesonidum [inn-latin]

36. Budesonido [inn-spanish]

37. (r)-budesonide

38. Inflammide

39. Budiair

40. Miflonide

41. Pulmaxan

42. Fvolir

43. 16,17-butylidenebis(oxy)-11,21-dihydroxypregna-1,4-diene-3,20-dione

44. Budesonide [usan:inn:ban:jan]

45. Rhinocort Allergy

46. Pulmaxan Turbohaler

47. Pulmicort (tn)

48. Pulmicort Topinasal

49. Rhinocort (tn)

50. Pulmicort Turbuhaler

51. Budesonide Easyhaler

52. S 1320

53. Ccris 5230

54. Entocort Ec (tn)

55. Sr-01000000101

56. Einecs 257-139-7

57. Mfcd00083259

58. Unii-q3oks62q6x

59. Jorveza

60. Eltair

61. Ultesa

62. Noex

63. Giona Easyhaler

64. 16?,17-[(1rs)-butylidenebis(oxy)]-11?,21-dihydroxypregna-1,4-diene-3,20-dione

65. Pregna-1,4-diene-3,20-dione, 16,17-[butylidenebis(oxy)]-11,21-dihydroxy-, (11.beta.,16.alpha.)-

66. Prestwick_840

67. Uceris (tn)

68. Ortikos

69. (11-beta,16-alpha)-16,17-(butylidenebis(oxy))-11,21-dihydroxypregna-1,4-diene-3,20-dione

70. 16-alpha,17-alpha-butylidenedioxy-11-beta,21-dihydroxy-1,4-pregnadiene-3,20-dione

71. (rs)-11beta,16alpha,17,21-tetrahydroxypregna-1,4-diene-3,20-dione Cyclic 16,17-acetal With Butyraldehyde

72. Budesonide, >=99%

73. Budesonide [mi]

74. Budesonide [inn]

75. Budesonide [jan]

76. Opera_id_1696

77. Prestwick0_000518

78. Prestwick1_000518

79. Prestwick2_000518

80. Prestwick3_000518

81. Budesonide [usan]

82. Budesonide [vandf]

83. Epitope Id:161750

84. B 7777

85. Schembl4096

86. (+)-16alpha,17alpha-butylidenedioxy-11beta,21-dihydroxy-1,4-pregnadiene-3,20-dione

87. Budesonide [usp-rs]

88. Budesonide [who-dd]

89. Chembl1370

90. Pregna-1,4-diene-3,20-dione,16,17-(butylidenebis(oxy))-11,21-dihydroxy-, (11beta,16alpha)-

91. Lopac0_000174

92. Bspbio_000475

93. Budesonide (jan/usp/inn)

94. Mls001077323

95. Mls002207112

96. Spbio_002396

97. Bpbio1_000523

98. Gtpl7434

99. Budesonide [orange Book]

100. Dtxsid8020202

101. Hsdb 8279

102. Budesonide [ep Monograph]

103. Uceris Component Budesonide

104. Budesonide [usp Monograph]

105. Hms1569h17

106. Hms2096h17

107. Hms2232d17

108. Hms3259h07

109. Hms3260d09

110. Hms3413b08

111. Hms3413p17

112. Hms3677b08

113. Hms3677p17

114. Hms3713h17

115. Breztri Component Budesonide

116. (rs)-11.beta.,16.alpha.,17,21-tetrahydroxypregna-1,4-diene-3,20-dione Cyclic 16,17-acetal With Butyraldehyde

117. 5-hydroxy-6b-(hydroxyacetyl)-4a,6a-dimethyl-8-propyl-4a,4b,5,6,6a,6b,9a,10,10a,10b,11,12-dodecahydro-2h-naphtho[2',1':4,5]indeno[1,2-d][1,3]dioxol-2-one

118. Act03247

119. Bcp05589

120. Eohilia (budesonide Oral Suspension)

121. Tox21_500174

122. Bdbm50354850

123. Symbicort Component Budesonide

124. Budesonide Component Of Uceris

125. Akos015969655

126. Budesonide Component Of Breztri

127. Ac-4697

128. Ccg-204269

129. Cs-2063

130. Db01222

131. Ks-1162

132. Lp00174

133. Nc00626

134. Nsc 757788

135. Sdccgsbi-0050162.p002

136. 11beta,21-dihydroxy-16alpha,17alpha-(butane-1,1-diyldioxy)pregna-1,4-diene-3,20-dione

137. Budesonide Component Of Symbicort

138. Ncgc00021318-05

139. Ncgc00021318-06

140. Ncgc00021318-08

141. Ncgc00021318-18

142. Ncgc00089747-04

143. Ncgc00260859-01

144. Bb164267

145. Budesonide 100 Microg/ml In Acetonitrile

146. Cpd000058337

147. Hy-13580

148. Pregna-1,4-diene-3,20-dione, 16,17-(butylidenebis(oxy))-11,21-dihydroxy-, (11-beta,16-alpha)-

149. Pregna-1,4-diene-3,20-dione, 16,17-butylidenebis(oxy)-11,21-dihydroxy-, (11beta,16alpha(r))-, And 16alpha,17-((s)-butylidenebis(oxy))-11beta,21-dihydroxypregna-1,4-diene-3,20-dione

150. B3909

151. Budesonide 100 Microg/ml In Methanol/water

152. Eu-0100174

153. D00246

154. T70986

155. 333b223

156. Q422212

157. J-504150

158. Q-101375

159. Sr-01000000101-2

160. Sr-01000000101-6

161. Brd-a34299591-001-03-4

162. Budesonide, European Pharmacopoeia (ep) Reference Standard

163. Budesonide, United States Pharmacopeia (usp) Reference Standard

164. Budesonide, Pharmaceutical Secondary Standard; Certified Reference Material

165. (11?,16?)-16,17-[butylidenebis(oxy)]-11,21-dihydroxypregna-1,4-diene-3,20-dione

166. (1s,2s,4r,8s,9s,11s,12s,13r)-11-hydroxy-8-(2-hydroxyacetyl)-9,13-dimethyl-6-propyl-5,7-dioxapentacyclo[10.8.0.0^{2,9}.0^{4,8}.0^{13,18}]icosa-14,17-dien-16-one

167. (4ar,4bs,5s,6as,6bs,9ar,10as,10bs)-6b-glycoloyl-5-hydroxy-4a,6a-dimethyl-8-propyl-4a,4b,5,6,6a,6b,9a,10,10a,10b,11,12-dodecahydro-2h-naphtho[2',1':4,5]indeno[1,2-d][1,3]dioxol-2-one

168. (6ar,6bs,7s,8as,8bs,11ar,12as,12bs)-7-hydroxy-8b-(2-hydroxyacetyl)-6a,8a-dimethyl-10-propyl-1,2,6a,6b,7,8,8a,8b,11a,12,12a,12b-dodecahydro-4h-naphtho[2',1':4,5]indeno[1,2-d][1,3]dioxol-4-one

2.4 Create Date
2005-06-24
3 Chemical and Physical Properties
Molecular Weight 430.5 g/mol
Molecular Formula C25H34O6
XLogP32.5
Hydrogen Bond Donor Count2
Hydrogen Bond Acceptor Count6
Rotatable Bond Count4
Exact Mass430.23553880 g/mol
Monoisotopic Mass430.23553880 g/mol
Topological Polar Surface Area93.1 Ų
Heavy Atom Count31
Formal Charge0
Complexity862
Isotope Atom Count0
Defined Atom Stereocenter Count8
Undefined Atom Stereocenter Count1
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 14  
Drug NameBudesonide
Drug LabelBudesonide, the active ingredient of ENTOCORT EC capsules, is a synthetic corticosteroid. It is designated chemically as (RS)-11, 16, 17,21-tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal with butyraldehyde. Budesonide is provided a...
Active IngredientBudesonide
Dosage FormSpray, metered; Capsule; Solution; Suspension
RouteNasal; Inhalation; Topical foam; Oral
Strength0.032mg/inh; 1mg/2ml; 0.5mg/2ml; 2mg; 3mg; 0.25mg/2ml
Market StatusTentative Approval; Prescription
CompanyWatson Labs; Barr Labs Div Teva; Teva Pharms; Apotex; Salix Pharms; Sandoz; Mylan

2 of 14  
Drug NameEntocort ec
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Drug LabelBudesonide, the active ingredient of ENTOCORT EC capsules, is a synthetic corticosteroid. It is designated chemically as (RS)-11, 16, 17,21-tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal with butyraldehyde. Budesonide is provided a...
Active IngredientBudesonide
Dosage FormCapsule
RouteOral
Strength3mg
Market StatusPrescription
CompanyAstrazeneca

3 of 14  
Drug NamePulmicort flexhaler
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Drug LabelBudesonide, the active component of PULMICORT FLEXHALER, is a corticosteroid designated chemically as (RS)-11, 16, 17,21-Tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal with butyraldehyde. Budesonide is provided as a mixture of two ep...
Active IngredientBudesonide
Dosage FormPowder, metered
RouteInhalation
Strength0.16mg/inh; 0.08mg/inh
Market StatusPrescription
CompanyAstrazeneca

4 of 14  
Drug NamePulmicort respules
Drug LabelBudesonide, the active component of PULMICORT RESPULES, is a corticosteroid designated chemically as (RS)-11, 16, 17, 21-tetrahydroxypregna-1, 4-diene-3, 20-dione cyclic 16, 17-acetal with butyraldehyde. Budesonide is provided as a mixture of t...
Active IngredientBudesonide
Dosage FormSuspension
RouteInhalation
Strength0.5mg/2ml; 0.25mg/2ml; 1mg/2ml
Market StatusPrescription
CompanyAstrazeneca

5 of 14  
Drug NameRhinocort
PubMed HealthBudesonide/Formoterol (By breathing)
Drug ClassesAntiasthma, Anti-Inflammatory/Bronchodilator Combination, Respiratory Agent
Drug LabelBudesonide, the active ingredient of RHINOCORT AQUA Nasal Spray, is an anti-inflammatory synthetic corticosteroid.It is designated chemically as (RS)-11-beta, 16-alpha, 17, 21-tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16, 17-acetal with butyrald...
Active IngredientBudesonide
Dosage FormSpray, metered
RouteNasal
Strength0.032mg/inh
Market StatusPrescription
CompanyAstrazeneca

6 of 14  
Drug NameSymbicort
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Active Ingredientformoterol fumarate dihydrate; Budesonide
Dosage FormAerosol, metered
RouteInhalation
Strength0.16mg/inh; 0.08mg/inh; 0.0045mg/inh
Market StatusPrescription
CompanyAstrazeneca

7 of 14  
Drug NameUceris
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Drug LabelUCERIS (budesonide) extended release tablets, for oral administration, contain budesonide, a synthetic corticosteroid, as the active ingredient. Budesonide is designated chemically as (RS)-11, 16, 17,21 tetrahydroxypregna-1,4-diene-3,20-dione cyc...
Active IngredientBudesonide
Dosage FormTablet, extended release
RouteOral
Strength9mg
Market StatusPrescription
CompanySantarus

8 of 14  
Drug NameBudesonide
Drug LabelBudesonide, the active ingredient of ENTOCORT EC capsules, is a synthetic corticosteroid. It is designated chemically as (RS)-11, 16, 17,21-tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal with butyraldehyde. Budesonide is provided a...
Active IngredientBudesonide
Dosage FormSpray, metered; Capsule; Solution; Suspension
RouteNasal; Inhalation; Topical foam; Oral
Strength0.032mg/inh; 1mg/2ml; 0.5mg/2ml; 2mg; 3mg; 0.25mg/2ml
Market StatusTentative Approval; Prescription
CompanyWatson Labs; Barr Labs Div Teva; Teva Pharms; Apotex; Salix Pharms; Sandoz; Mylan

9 of 14  
Drug NameEntocort ec
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Drug LabelBudesonide, the active ingredient of ENTOCORT EC capsules, is a synthetic corticosteroid. It is designated chemically as (RS)-11, 16, 17,21-tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal with butyraldehyde. Budesonide is provided a...
Active IngredientBudesonide
Dosage FormCapsule
RouteOral
Strength3mg
Market StatusPrescription
CompanyAstrazeneca

10 of 14  
Drug NamePulmicort flexhaler
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Drug LabelBudesonide, the active component of PULMICORT FLEXHALER, is a corticosteroid designated chemically as (RS)-11, 16, 17,21-Tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal with butyraldehyde. Budesonide is provided as a mixture of two ep...
Active IngredientBudesonide
Dosage FormPowder, metered
RouteInhalation
Strength0.16mg/inh; 0.08mg/inh
Market StatusPrescription
CompanyAstrazeneca

11 of 14  
Drug NamePulmicort respules
Drug LabelBudesonide, the active component of PULMICORT RESPULES, is a corticosteroid designated chemically as (RS)-11, 16, 17, 21-tetrahydroxypregna-1, 4-diene-3, 20-dione cyclic 16, 17-acetal with butyraldehyde. Budesonide is provided as a mixture of t...
Active IngredientBudesonide
Dosage FormSuspension
RouteInhalation
Strength0.5mg/2ml; 0.25mg/2ml; 1mg/2ml
Market StatusPrescription
CompanyAstrazeneca

12 of 14  
Drug NameRhinocort
PubMed HealthBudesonide/Formoterol (By breathing)
Drug ClassesAntiasthma, Anti-Inflammatory/Bronchodilator Combination, Respiratory Agent
Drug LabelBudesonide, the active ingredient of RHINOCORT AQUA Nasal Spray, is an anti-inflammatory synthetic corticosteroid.It is designated chemically as (RS)-11-beta, 16-alpha, 17, 21-tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16, 17-acetal with butyrald...
Active IngredientBudesonide
Dosage FormSpray, metered
RouteNasal
Strength0.032mg/inh
Market StatusPrescription
CompanyAstrazeneca

13 of 14  
Drug NameSymbicort
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Active Ingredientformoterol fumarate dihydrate; Budesonide
Dosage FormAerosol, metered
RouteInhalation
Strength0.16mg/inh; 0.08mg/inh; 0.0045mg/inh
Market StatusPrescription
CompanyAstrazeneca

14 of 14  
Drug NameUceris
PubMed HealthBudesonide
Drug ClassesAnti-Inflammatory, Endocrine-Metabolic Agent, Gastrointestinal Agent
Drug LabelUCERIS (budesonide) extended release tablets, for oral administration, contain budesonide, a synthetic corticosteroid, as the active ingredient. Budesonide is designated chemically as (RS)-11, 16, 17,21 tetrahydroxypregna-1,4-diene-3,20-dione cyc...
Active IngredientBudesonide
Dosage FormTablet, extended release
RouteOral
Strength9mg
Market StatusPrescription
CompanySantarus

4.2 Therapeutic Uses

Anti-Inflammatory Agents; Bronchodilator Agents; Glucocorticoids

National Library of Medicine's Medical Subject Headings. Budesonide. Online file (MeSH, 2015). Available from, as of November 20, 2015: https://www.nlm.nih.gov/mesh/MBrowser.html


/CLINICAL TRIALS/ ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. The Web site is maintained by the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Each ClinicalTrials.gov record presents summary information about a study protocol and includes the following: Disease or condition; Intervention (for example, the medical product, behavior, or procedure being studied); Title, description, and design of the study; Requirements for participation (eligibility criteria); Locations where the study is being conducted; Contact information for the study locations; and Links to relevant information on other health Web sites, such as NLM's MedlinePlus for patient health information and PubMed for citations and abstracts for scholarly articles in the field of medicine. Budesonide is included in the database.

NIH/NLM; ClinicalTrials.Gov. Available from, as of September 30, 2015: https://clinicaltrials.gov/search/intervention=budesonide


Budesonide capsules (enteric coated) are indicated for the treatment of mild to moderate active Crohn's disease involving the ileum and/or the ascending colon. /Included in US product label/

NIH; DailyMed. Current Medication Information for Budesonide (Budesonide) Capsule (Updated: March 2014). Available from, as of November 20, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4a578d93-087e-42f7-a258-a49afef41dea


Budesonide capsules (enteric coated) are indicated for the maintenance of clinical remission of mild to moderate Crohn's disease involving the ileum and/or the ascending colon for up to 3 months. /Included in US product label/

NIH; DailyMed. Current Medication Information for Budesonide (Budesonide) Capsule (Updated: March 2014). Available from, as of November 20, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4a578d93-087e-42f7-a258-a49afef41dea


For more Therapeutic Uses (Complete) data for Budesonide (13 total), please visit the HSDB record page.


4.3 Drug Warning

Intranasal budesonide therapy should be used with caution, if at all, in patients with clinical or asymptomatic Mycobacterium tuberculosis infections of the respiratory tract, untreated fungal or bacterial infections, or ocular herpes simplex or untreated, systemic viral infections.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 2810


Localized candidal infections of the nose and/or pharynx have occurred rarely during intranasal budesonide therapy. When infection occurs, appropriate local or systemic treatment of the infection may be necessary, and/or discontinuance of intranasal budesonide therapy may be required. Patients receiving the drug for several months or longer should be examined periodically for candidal infections or changes in the nasal mucosa. Nasal septum perforation and increased intraocular pressure (IOP) have been reported rarely in patients receiving budesonide nasal spray. Because corticosteroid therapy may inhibit wound healing, patients with recent nasal septum ulcers, nasal surgery, or nasal trauma should not use nasal corticosteroids until healing has occurred.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 2810


Patients who are taking immunosuppressant drugs have increased susceptibility to infections compared with healthy individuals, and certain infections (e.g., varicella [chickenpox], measles) can have a more serious or even fatal outcome in such patients, particularly in children. In patients who have not had these diseases, particular care should be taken to avoid exposure. It is not known how the dosage, route, and duration of administration of a corticosteroid or the contribution of the underlying disease and/or prior corticosteroid therapy affect the risk of developing a disseminated infection. If exposure to varicella (chickenpox) or measles occurs in such individuals, administration of varicella zoster immune globulin (VZIG) or pooled IM immune globulin (IG) respectively, may be initiated. If varicella (chickenpox) develops, treatment with an antiviral agent may be considered.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 2810


Adverse effects of budesonide occurring in 2% or more of patients receiving budesonide nasal spray and with an incidence more frequent than that of placebo include epistaxis, pharyngitis, bronchospasm, cough, and nasal irritation.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 2810


For more Drug Warnings (Complete) data for Budesonide (17 total), please visit the HSDB record page.


4.4 Drug Indication

Budesonide extended release capsules are indicated for the treatment and maintenance of mild to moderate Crohns disease. Various inhaled budesonide products are indicated for prophylactic therapy in asthma and reducing exacerbations of COPD. A budesonide nasal spray is available over the counter for symptoms of hay fever and upper respiratory allergies. Extended-release capsules are indicated to induce remission of mild to moderate ulcerative colitis and a rectal foam is used for mild to moderate distal ulcerative colitis. In addition, a delayed-release capsule formulation of budesonide is indicated to reduce proteinuria in adults with IgA nephropathy at risk of rapid disease progression.


FDA Label


Jorveza is indicated for the treatment of eosinophilic esophagitis (EoE) in adults (older than 18 years of age).


Treatment of asthma


Treatment of asthma


Prevention of bronchopulmonary dysplasia


Treatment of primary IgA nephropathy


Kinpeygo is indicated for the treatment of primary immunoglobulin A (IgA) nephropathy (IgAN) in adults at risk of rapid disease progression with a urine protein-to-creatinine ratio (UPCR) 1. 5 g/gram.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Budesonide is a glucocorticoid used to treat respiratory and digestive conditions by reducing inflammation. It has a wide therapeutic index, as dosing varies highly from patient to patient. Patients should be counselled regarding the risk of hypercorticism and adrenal axis suppression.


5.2 MeSH Pharmacological Classification

Bronchodilator Agents

Agents that cause an increase in the expansion of a bronchus or bronchial tubes. (See all compounds classified as Bronchodilator Agents.)


Anti-Inflammatory Agents

Substances that reduce or suppress INFLAMMATION. (See all compounds classified as Anti-Inflammatory Agents.)


Glucocorticoids

A group of CORTICOSTEROIDS that affect carbohydrate metabolism (GLUCONEOGENESIS, liver glycogen deposition, elevation of BLOOD SUGAR), inhibit ADRENOCORTICOTROPIC HORMONE secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. (See all compounds classified as Glucocorticoids.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
BUDESONIDE
5.3.2 FDA UNII
Q3OKS62Q6X
5.3.3 Pharmacological Classes
Corticosteroid [EPC]; Corticosteroid Hormone Receptor Agonists [MoA]
5.4 ATC Code

A07EA06


A07EA06


A07EA06

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355


A - Alimentary tract and metabolism

A07 - Antidiarrheals, intestinal antiinflammatory/antiinfective agents

A07E - Intestinal antiinflammatory agents

A07EA - Corticosteroids acting locally

A07EA06 - Budesonide


D - Dermatologicals

D07 - Corticosteroids, dermatological preparations

D07A - Corticosteroids, plain

D07AC - Corticosteroids, potent (group iii)

D07AC09 - Budesonide


R - Respiratory system

R01 - Nasal preparations

R01A - Decongestants and other nasal preparations for topical use

R01AD - Corticosteroids

R01AD05 - Budesonide


R - Respiratory system

R03 - Drugs for obstructive airway diseases

R03B - Other drugs for obstructive airway diseases, inhalants

R03BA - Glucocorticoids

R03BA02 - Budesonide


5.5 Absorption, Distribution and Excretion

Absorption

Extended release oral capsules are 9-21% bioavailable. A 9mg dose reaches a Cmax of 1.500.79ng/mL with a Tmax of 2-8h and an AUC of 7.33ng\*hr/mL. A high fat meal increases the Tmax by 2.3h but otherwise does not affect the pharmacokinetics of budesonide. 180-360g metered inhaled doses of budesonide are 34% deposited in the lungs, 39% bioavailable, and reach a Cmax of 0.6-1.6nmol/L with a Tmax of 10 minutes. A 1mg nebulized dose is 6% bioavailable, reaching a Cmax of 2.6nmol/L with a Tmax of 20 minutes. A 9mg oral extended release tablet reaches a Cmax of 1.350.96ng/mL with a Tmax of 13.35.9h and an AUC of 16.4310.52ng\*hr/mL. Budesonide rectal foam 2mg twice daily has an AUC of 4.31ng\*hr/mL.


Route of Elimination

Approximately 60% of a budesonide dose is recovered in the urine as the major metabolites 6beta-hydroxybudesonide, 16alpha-hydroxyprednisolone, and their conjugates. No unchanged budesonide is recovered in urine.


Volume of Distribution

The volume of distribution of budesonide is 2.2-3.9L/kg.


Clearance

Budesonide has a plasma clearance of 0.9-1.8L/min. The 22R form has a clearance of 1.4L/min while the 22S form has a clearance of 1.0L/min. The clearance in asthmatic children 4-6 years old is 0.5L/min.


/MILK/ Not known whether budesonide is distributed in milk.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 2810


When budesonide is administered intranasally, approximately 34% of a dose reaches systemic circulation. Mean peak plasma budesonide concentrations are achieved in about 0.7 hours.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 2810


Inhaled corticosteroids (ICS) are mainstay treatment of asthma and chronic obstructive pulmonary disease. However, highly lipophilic ICS accumulate in systemic tissues, which may lead to adverse systemic effects. The accumulation of a new, highly lipophilic ICS, ciclesonide and its active metabolite (des-CIC) has not yet been reported. Here, we have compared tissue accumulation of des-CIC and an ICS of a moderate lipophilicity, budesonide (BUD), after 14 days of once-daily treatment in mice. Single, three or 14 daily doses of [(3) H]-des-CIC or [(3) H]-BUD were administered subcutaneously to male CD1 albino mice, which were killed at 4 hrs, 24 hrs or 5 days after the last dose. Distribution of tissue concentration of radioactivity was studied by quantitative whole-body autoradiography. Pattern of radioactivity distribution across most tissues was similar for both corticosteroids after a single as well as after repeated dosing. However, tissue concentration of radioactivity differed between des-CIC and BUD. After a single dose, concentrations of radioactivity for both corticosteroids were low for most tissues but increased over 14 days of daily dosing. The tissue radioactivity of des-CIC at 24 hrs and 5 days after the 14th dose was 2-3 times higher than that of BUD in majority of tissues. Tissue accumulation, assessed as concentration of tissue radioactivity 5 days after the 14th versus 3rd dose, showed an average ratio of 5.2 for des-CIC and 2.7 for BUD (p < 0.0001). In conclusion, des-CIC accumulated significantly more than BUD. Systemic accumulation may lead to increased risk of adverse systemic side effects during long-term therapy.

PMID:23256845 Mars U et al; Basic Clin Pharmacol Toxicol 112(6): 401-11 (2013).


5.6 Metabolism/Metabolites

Budesonide is 80-90% metabolized at first pass. Budesonide is metabolized by CYP3A to its 2 major metabolites, 6beta-hydroxybudesonide and 16alpha-hydroxyprednisolone. The glucocorticoid activity of these metabolites is negligible (<1/100) in relation to that of the parent compound. CYP3A4 is the strongest metabolizer of budesonide, followed by CYP3A5, and CYP3A7.


Budesonide is metabolized in the liver by the cytochrome P-450 (CYP) isoenzyme 3A4; the 2 main metabolites have less than 1% of affinity for glucocorticoid receptors than the parent compound. Budesonide is excreted in urine and feces as metabolites.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 2810


Asthma is one of the most prevalent diseases in the world, for which the mainstay treatment has been inhaled glucocorticoids (GCs). Despite the widespread use of these drugs, approximately 30% of asthma sufferers exhibit some degree of steroid insensitivity or are refractory to inhaled GCs. One hypothesis to explain this phenomenon is interpatient variability in the clearance of these compounds. The objective of this research is to determine how metabolism of GCs by the CYP3A family of enzymes could affect their effectiveness in asthmatic patients. In this work, the metabolism of four frequently prescribed inhaled GCs, triamcinolone acetonide, flunisolide, budesonide, and fluticasone propionate, by the CYP3A family of enzymes was studied to identify differences in their rates of clearance and to identify their metabolites. Both interenzyme and interdrug variability in rates of metabolism and metabolic fate were observed. CYP3A4 was the most efficient metabolic catalyst for all the compounds, and CYP3A7 had the slowest rates. CYP3A5, which is particularly relevant to GC metabolism in the lungs, was also shown to efficiently metabolize triamcinolone acetonide, budesonide, and fluticasone propionate. In contrast, flunisolide was only metabolized via CYP3A4, with no significant turnover by CYP3A5 or CYP3A7. Common metabolites included 6 Beta-hydroxylation and Delta (6)-dehydrogenation for triamcinolone acetonide, budesonide, and flunisolide. The structure of Delta (6)-flunisolide was unambiguously established by NMR analysis. Metabolism also occurred on the D-ring substituents, including the 21-carboxy metabolites for triamcinolone acetonide and flunisolide. The novel metabolite 21-nortriamcinolone acetonide was also identified by liquid chromatography-mass spectrometry and NMR analysis.

PMID:23143891 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558858 Moore CD et al; Drug Metab Dispos 41(2): 379-89 (2013).


5.7 Biological Half-Life

Budesonide has a plasma elimination half life of 2-3.6h. The terminal elimination half life in asthmatic children 4-6 years old is 2.3h.


5.8 Mechanism of Action

The short term effects of corticosteroids are decreased vasodilation and permeability of capillaries, as well as decreased leukocyte migration to sites of inflammation. Corticosteroids binding to the glucocorticoid receptor mediates changes in gene expression that lead to multiple downstream effects over hours to days. Glucocorticoids inhibit neutrophil apoptosis and demargination; they inhibit phospholipase A2, which decreases the formation of arachidonic acid derivatives; they inhibit NF-Kappa B and other inflammatory transcription factors; they promote anti-inflammatory genes like interleukin-10. Lower doses of corticosteroids provide an anti-inflammatory effect, while higher doses are immunosuppressive. High doses of glucocorticoids for an extended period bind to the mineralocorticoid receptor, raising sodium levels and decreasing potassium levels.


To investigate the roles of signal transduction and activator of transcription 6 (STAT6) and orosomucoid 1-like 3 (ORMDL3) in airway remodeling among asthmatic mice and to observe the effects of budesonide (BUD) on their expression, thirty mice were randomly divided into control, asthma, and BUD intervention group. The mice were sensitized and challenged with ovalbumin (OVA) to establish a mouse model of asthma. The BUD intervention group received aerosol inhalation of BUD dissolved in normal saline 30 minutes before each OVA challenge, while normal saline was used instead of OVA solution in the control group. The pathological changes in the airway were observed by hematoxylin-eosin staining and Masson staining. The interleukin-13 (IL-13) level in lung homogenate was measured by enzyme-linked immunosorbent assay. The mRNA expression of STAT6 and ORMDL3 was measured by RT-PCR. The asthma group showed more pathological changes in the airway than the control and BUD intervention groups, and the BUD intervention group had reduced pathological changes in the airway compared with the asthma group. The asthma and BUD intervention groups had significantly higher IL-13 levels and mRNA expression of STAT6 and ORMDL3 than the control group (P<0.05), and these indices were significantly higher in the asthma group than in the BUD intervention group (P<0.05). The Pearson correlation analysis showed that STAT6 mRNA expression was positively correlated with ORMDL3 mRNA expression (r=0.676, P=0.032). STAT6 and ORMDL3 may be involved in the airway remodeling of mice, and BUD can reduce airway remodeling in asthmatic mice, possibly by down-regulating mRNA expression of STAT6 and ORMDL3.

PMID:24568918 Zou LP et al; Zhongguo Dang Dai Er Ke Za Zhi 16(2): 198-202 (2014).


Mucus hypersecretion from airway epithelium is a characteristic feature of severe asthma. Glucocorticoids (GCs) may suppress mucus production and diminish the harmful airway obstruction. We investigated the ability of GCs to suppress mRNA expression and protein synthesis of a gene encoding mucin, MUC5AC, induced by transforming growth factor (TGF)-alpha in human mucoepidermoid carcinoma (NCI-H292) cells and the molecular mechanisms underlying the suppression. We determined if GCs such as dexamethasone (DEX), budesonide (BUD), and fluticasone (FP) could suppress MUC5AC production induced by a combination of TGF-alpha and double-strand RNA, polyinosinic-polycytidylic acid (polyI:C). MUC5AC mRNA expression and MUC5AC protein production were evaluated. The signaling pathways activated by TGF-alpha and their inhibition by GCs were tested using a phosphoprotein assay and MUC5AC promoter assay. DEX significantly suppressed the expression of MUC5AC mRNA and MUC5AC protein induced by TGF-alpha. The activation of the MUC5AC promoter by TGF-alpha was significantly inhibited by DEX. DEX did not affect activation of downstream pathways of the EGF receptor or mRNA stability of MUC5AC transcripts. DEX, BUD, and FP suppressed MUC5AC protein expression induced by a combination of TGF-alpha and polyI:C in a dose-dependent manner. GCs inhibited MUC5AC production induced by TGF-alpha alone or a combination of TGF-alpha and polyI:C; the repression may be mediated at the transcriptional but not post-transcriptional level.

PMID:22824974 Takami S et al; Allergol Int 61(3): 451-9 (2012).