Pulmicort Slurry (Oral Viscous Budesonide): How this medication is taken
No medication is currently FDA approved for treatment of eosinophilic esophagitis. All medications prescribed for EoE prescribed should be considered as off-label and experimental. Therefore any decision to start treatment and continued monitoring should be discussed carefully with your medical provider.
Budesonide (Pulmicort) is an steroid medication that has been used to treat asthma. In recent years, it has also been used as an effective therapy to treat the eosinophilic inflammation in EoE. This type of therapy has been known as oral viscous budesonide (OVB) or a Pulmicort slurry.
Budesonide comes in two types of delivery devices:
– Liquid respules which are used with a nebulizer machine to deliver aerosolized steroid via a mist
– Dry powder inhaler (DPI) which deliver steroids when a patient breathes in from these handheld devices
The respules, not the DPI, should be used to treat EoE since the DPI is designed to promote steroid delivery to the lungs and not the esophagus.
This medication should only be taken under the supervision of a physician. If using this medication you need to consult with your doctor regarding appropriate dosages. Budesonide (Pulmicort) respules come in varying doses: 0.25 mg, 0.5 mg, and 1 mg strengths. However, treatment with 0.5 mg respules are commonly used to create the necessary volume to coat the esophagus. Doses used in studies range from 1 mg (2 respules) to 2 mg (4 respules) taken once per day.
When using budesonide, the goal is to make the respule solution into a thickened consistency and sufficient volume to coat the entire length of the esophagus. A study on Pulmicort slurries used a mixture of 5 packets of sucralose (Splenda) for EACH 0.5 mg respule being used. This mixture then is swallowed. No food or drinks should be taken for 30 minutes afterwards to prevent the steroid from washing off the esophagus. Rinsing and spitting or brushing teeth afterwards may help to minimize steroid deposition within the mouth.