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Treatment of EoE with Oral Viscous Budesonide

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This information was reviewed and approved by Christine B. Cho, MD (11/1/2018).

Your doctor has recommended budesonide to treat your EoE (eosinophilic esophagitis). Budesonide comes as a liquid that is usually inhaled in a nebulizer. Budesonide is an inhaled steroid. An inhaled steroid prevents and reduces swelling (inflammation). Instead of inhaling the liquid from a nebulizer you will swallow the solution. This will coat the esophagus. First you will mix the budesonide to create a viscous (thickened) solution. You will swallow the solution twice a day, after breakfast and after dinner.

Splenda® is the most studied vehicle for administration of budesonide, but there are other options if you prefer. Here are the amounts recommended of each possible vehicle:

  • Splenda — 5 packets

  • Applesauce — 1 teaspoon

  • Honey or agave nectar — 1 teaspoon


Please follow these directions to mix the oral viscous budesonide solution you will swallow:

  1. Open the individual medicine container (Budesonide respule) by gently twisting off the top tab.

  2. Pour the liquid medicine into a small cup (measuring cup or medicine cup). A Budesonide respule contains 2 ml or less than ½ teaspoon of medicine.

  3. Add the vehicle. Mix the solution until it is a slurry-like consistency for one dose. The goal is to make the solution into a thickened consistency with sufficient volume to coat the esophagus.

  4. Swallow all the medicine solution.

  5. Do not eat or drink anything for one hour after taking the medicine solution. You may rinse your mouth and spit out the water or brush your teeth after you swallow the medicine, but do not swallow the water.

Continue taking this medicine in the viscous solution until your doctor tells you it is no longer necessary. Your doctor may schedule you to have a repeat upper endoscopy to take extra biopsy samples from the esophagus. The biopsy can show if the inflammation has improved with the medicine. The interval for endoscopy will be determined by your doctor and will be based on your symptoms and the length of treatment.

In general, this medicine is well tolerated. The main side effects can include a hoarse voice or sore throat. Some people develop a yeast infection (candida) of the mouth (thrush) or esophagus. If you notice white spots on your tongue or in your mouth, call your doctor. This can be treated with a short course of antibiotics. Rinsing your mouth and spitting out the water will also help prevent thrush.

Ask your health care provider if you have any questions.


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