Rectal budesonide has joined prednisolone and hydrocortisone on the PBS for treatment of active ulcerative colitis. Budenofalk® delivers 14 doses of 2mg budesonide in a small (20-30 mL) foam enema from an easy-to-use metered dose aerosol canister.
Topical corticosteroids are preferred over oral and intravenous options to combine local efficacy with reduced corticosteroid-related systemic adverse effects. Systemic corticosteroids should be tapered carefully when transferring to rectal budesonide, as the minimal absorption is unlikely to maintain plasma levels that cause adrenocortical suppression.
Budesonide rectal foam is well tolerated overall, although burning in the rectum or pain is common, and caution is recommended in patients where administration of glucocorticoids may have undesirable effects, including the masking of infections.
The Therapeutic guidelines: gastrointestinal, 2011 recommend adding rectal corticosteroids for left-sided ulcerative colitis only after oral, plus, rectal aminosalicylates have proven ineffective.
- Budenofalk® (budesonide) Foam Enema Australian approved product information. St Leonards: Orphan Australia Pty Ltd. Approved 12 June 2012.
- Therapeutic Goods Administration. Australian Public Assessment Report for Budesonide. Canberra; Therapeutic Goods Administration; 2012.
- Gastrointestinal Expert Group. Therapeutic guidelines: gastrointestinal. Version 5. Melbourne: Therapeutic Guidelines Limited; 2011.