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Budesonide for Veterinary Use – IBD in Cats and Dogs

For Veterinary Practices
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For Pet & Horse Owners
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By Evan Ware, DVM

Overview

Therapeutic Class
Corticosteroid

Species
Dogs and cats

May Be Prescribed by Vets for:
Inflammatory Bowel Disease (IBD).

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Basic Information

Budesonide is a locally acting corticosteroid that is used by veterinarians to treat inflammatory bowel disease (IBD) and some types of colitis in cats and dogs. While this medication is not a cure for IBD, budesonide has been shown to aid in symptom control.

In humans, the enteric-coated oral form is used to treat or to manage Crohn's Disease and the inhaled formulations are used to manage asthma and allergies. Because of its low systemic-bioavailability and high first-pass hepatic metabolism, it is regarded as a "topical" corticosteroid at the site of delivery. In large-scale clinical trials in humans with mild to moderate Crohn's Disease, budesonide was well tolerated with fewer corticosteroid-related adverse effects than prednisolone. The presence of food in the GI tract will affect the speed but not the amount of the drug that is absorbed.

Veterinary Medicine Uses for Budesonide

You can obtain a customized formulation of this medication through a qualified veterinary compounding pharmacy in dosage forms such as capsule, tablet, oral suspension, or transdermal gel.

IBD is a common problem and a diagnostic challenge in small-animal practice. It is seen in both dogs and cats, although the presentation is somewhat different. The diagnosis of IBD is based on histologic evidence of inflammation in the intestine. Further classification is based on the affected region of the intestine and the predominant cell-type in the infiltrate.

Diagnostic tests include CBC, chemistry, fecal cytology and parasitology, urinalysis, abdominal radiograph and ultrasound and, ultimately, intestinal biopsy. There are some breeds including Basenjis, Wheaten Terriers, Boxers and Norwegian Lundehunds with an increased incidence of specific forms of IBD.

Animals rarely are cured of IBD unless a specific underlying cause (such as parasitism) is determined and, more commonly, the goal of therapy is to control clinical signs with the minimum number of drugs. The majority (85%) of cats with IBD respond favorably to corticosteroid therapy.

Budesonide is a newer corticosteroid that, in some instances, can replace prednisone or prednisolone for immunosuppression therapy. Although research has demonstrated hypothalamopituitary-adrenal suppression in normal dogs receiving budesonide, many side-effects associated with long-term corticosteroid therapy were not as apparent.

The human budesonide product is enteric coated; non-enteric-coated formulations can be preferable in small animals because the location of IBD tends to be more proximal within the GI tract in dogs and cats.

Potential Side-Effects of Budesonide

Some animals can be sensitive or allergic to the medication. Common potential side-effects associated with budesonide include increased appetite, increased thirst, increased urination, and changes in hair coat.

If an animal experiences muscle loss, weakness, black and tarry stools, blood in the stool, or a “pot belly” while taking budesonide, immediate veterinarian care is needed. Although corticosteroid-related side-effects are less common with budesonide, they include polyuria, polydipsia, increased appetite, and changes in hair coat.

Do not discontinue this medication abruptly, as it can cause severe weakness, vomiting, collapse and, in severe cases, sudden death.

Drug Interactions with Budesonide

Budesonide should not be used concomitantly with erythromycin, cimetidine, ketoconazole, itraconazole, fluconazole, and diltiazem. Budesonide is metabolized by a hepatic enzyme (CYP3A), which is inhibited by these drugs.

Oral antacids will dissolve the enteric coating of budesonide. Simultaneous dosing with omeprazole has been studied in humans and does not affect the pharmacokinetics of budesonide.

Precautions for Using Budesonide

Budesonide should be used with caution if an animal is suffering from an active infection, ulcers, cataracts, diabetes, or liver impairments. This medication also has the potential to interact with other medications, so it's important for the prescribing veterinarian to be aware of any existing drug regimen. Common medication interactions include fluconazole, itraconazole, ketoconazole, diltiazem, cimetidine, and erythromycin.

Because budesonide is a corticosteroid, it should be used with additional caution in animals with GI ulceration, active infection, diabetes, or cataracts. Additional corticosteroid supplementation can be needed for budesonide treated animals undergoing surgery.

There has been positive research in humans on using budesonide during pregnancy for women with Crohn's Disease. The FDA considers budesonide a Category C drug. Experimentally, massive (100x) overdose was lethal in mice. In case of overdose, prompt gut-evacuation can be indicated.

After giving this medication to an animal, wash your hands thoroughly.

Dosage and Administration of Budesonide

It is important that budesonide is given in the manner and frequency indicated by the veterinarian. If a dose is missed, the pet owner should not double the next dose. The pet owner should give the missed dose as soon as possible, but if it is close in time to the next scheduled dose, skip the missed dose and administer the medication again according to the schedule.

About the Author

Dr. Evan Ware

Dr. Evan Ware is a veterinary practitioner in Phoenix, Arizona. He received both his undergraduate degree in microbiology and his Doctorate of Veterinary Medicine from The Ohio State University.

Dr. Ware is currently the Medical Director of University Animal Hospital (VCA) and is also the owner of two other hospitals, including Laveen Veterinary Center and Phoenix Veterinary Center. His areas of expertise include orthopedic medicine and surgery, veterinary oncology and chemotherapy, and general and advanced soft-tissue surgery.