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Budesonide is a glucocorticoid with high topical potency and extensive first-pass hepatic metabolism (>90%), dramatically reducing systemic side effects. Custom GI formulations deliver concentrated anti-inflammatory effects to the esophagus, small intestine, or colon while minimizing adrenal suppression and systemic steroid effects.
Commercial budesonide targets specific GI segments (Entocort for ileum; Uceris for colon). Compounding pharmacies prepare viscous slurry for EoE esophageal coating, immediate-release capsules for gastric targeting, lower pediatric doses, and liquid formulations for those unable to swallow capsules.
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Budesonide oral viscous suspension (slurry) has been the standard of care for eosinophilic esophagitis (EoE) despite no FDA-approved slurry form until recently (Eohilia approved 2024). For MCAS patients with GI involvement, compounded budesonide addresses intestinal mast cell activation with far less systemic effect than prednisone.
Eosinophilic esophagitis (EoE), Crohn's disease (ileal/right colon), microscopic colitis, mast cell activation syndrome (GI manifestations), eosinophilic gastroenteritis.
EoE slurry: 0.5–1mg/mL viscous solution, 2–4mL swallowed slowly twice daily after meals. Crohn's: 6–9mg daily in divided doses. Microscopic colitis: 6mg daily for 8 weeks then taper. Pediatric: weight-based dosing.
Adrenal suppression (less than systemic steroids), oral or esophageal candidiasis (rinse mouth after use), growth effects in children with long-term use. Significantly fewer systemic effects than prednisone.
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