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Budesonide side effects and how to avoid them

Budesonide side effects include hypercorticism, adrenal gland dysfunction, and more
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By | Oct. 28, 2022 Medically reviewed by Megan Huang, Pharm.D.
Rx capsules and pill bottle: Budesonide side effects and how to avoid them

Key takeaways

  • Budesonide is a corticosteroid used to treat conditions like Crohn’s disease, ulcerative colitis, asthma, and seasonal allergies, available in forms such as tablets, inhalants, nasal spray, and rectal foam, with side effects varying by administration method.

  • Common side effects of budesonide include headache, respiratory infections, nausea, and more serious effects like hypercorticism, adrenal gland dysfunction, and immune system suppression, depending on the form and duration of treatment.

  • Long-term use of budesonide can lead to serious side effects such as hypercorticism, adrenal gland dysfunction, immune suppression, cataracts, osteoporosis, and growth suppression, with risks varying based on how the medication is administered.

  • To minimize side effects, patients should follow prescription instructions carefully, avoid grapefruit, take calcium and vitamin D supplements, practice infection prevention measures, and consult healthcare providers about any existing medical conditions or medications.

In this article:

Budesonide is a generic prescription corticosteroid. As a pill, budesonide is used to treat Crohn’s disease or ulcerative colitis. Rectal foam is an alternative to pills for people with ulcerative colitis located near the anus. Budesonide inhalant provides asthma maintenance treatment for young children, helping to reduce the frequency and severity of asthma attacks. Budesonide is frequently combined with other medications in a single inhaler to help keep airways open in adults with asthma, emphysema, or chronic bronchitis. Finally, as a prescription or over-the-counter nasal spray, budesonide helps relieve nasal symptoms of seasonal allergies such as runny nose. For some, budesonide can be prescribed in a brand-name version like Uceris (tablet or rectal foam), Pulmicort (inhalant), or Rhinocort (nasal spray). As a corticosteroid, budesonide reduces swelling in the colon, lungs, or nose by blocking the immune system. It has many of the standard side effects typical of corticosteroids, though budesonide inhalants, nasal spray, or rectal foam are less likely to cause problems.

Common side effects of budesonide

Based on clinical trials, the most common side effect of budesonide capsules or tablets is headache followed by:

  • Respiratory infection
  • Nausea
  • Hypercorticism (Cushing syndrome)
  • Back pain
  • Indigestion
  • Dizziness
  • Stomach pain
  • Flatulence
  • Vomiting
  • Fatigue
  • Pain
  • Abdominal distension
  • Mood changes

Since inhaled budesonide is applied topically to the lung’s surface, less budesonide enters the bloodstream than when taken as a pill. Side effects, then, are less commonly experienced. The most common side effects of inhaled budesonide are:

  • Respiratory infections
  • Stuffy nose
  • Ear infection
  • Coughing
  • Viral infection
  • Digestive system problems
  • Diarrhea
  • Yeast infection (oral thrush)
  • Stomach pain
  • Conjunctivitis
  • Skin rash
  • Vomiting

Budesonide nasal spray is also less likely to cause side effects which mainly affect the nose, sinuses, and throat. The most common side effects of budesonide nasal spray are:

  • Nosebleed
  • Sore throat
  • Airway closure (bronchospasm)
  • Coughing
  • Nasal irritation

Budesonide aerosol rectal foam is also a topical treatment. In this case, it is applied topically to the first 15 inches or so of the colon near the rectum. The most common side effect is a drop in the body’s cortisol levels. The only other significant side effects are suppression of the adrenal gland (adrenal insufficiency) and nausea.

Serious side effects of budesonide

The most serious side effects of oral budesonide include:

  • High fluid pressure in the brain (intracranial hypertension)
  • High blood pressure
  • Infection
  • High blood sugar 
  • Gastrointestinal obstruction
  • Suppression of the adrenal gland
  • Hypercorticism (Cushing syndrome)
  • Suppression of the immune system
  • Glaucoma (high pressure in the eye)
  • Cataracts
  • Osteoporosis
  • Growth suppression of children
  • Withdrawal symptoms
  • Severe allergic reaction

The most serious side effects of inhaled budesonide include:

  • Psychiatric disorders
  • Hypercorticism
  • Cataracts
  • Glaucoma
  • Osteoporosis
  • Growth suppression
  • Severe allergic reactions

The most serious side effects of budesonide nasal spray include:

  • Cataracts
  • Glaucoma
  • Osteoporosis
  • Growth suppression
  • Severe allergic reactions

Budesonide and hypercorticism

The most common side effect of the chronic use of budesonide is hypercorticism, also called Cushing syndrome. Steroids like budesonide imitate a hormone in the body called cortisol. Hypercorticism simply means “too much cortisol.” The incidence is highest in people taking budesonide orally since more of the drug enters the bloodstream. However, even when taken as an inhalant or nasal spray, some budesonide does get into the bloodstream. Over time, the excess corticosteroids—too much cortisol, that is—change the body and the way it works. These changes include acne, easy bruising, swollen face (or “moon face”), unwanted hair growth, stretch marks, and fat buildup at the back of the neck (buffalo hump). Weight gain and muscle weakness can also result from the prolonged use of corticosteroids. Most of these effects will improve once the corticosteroid treatment ends, but some could be long-lasting.

How soon do budesonide side effects start?

Many of the most common side effects of budesonide start early in treatment, sometimes after the first dose. These include headache, dizziness, digestive system problems, and mood changes. Some of the most serious side effects are delayed side effects, but an allergic reaction can happen within minutes of the first dose. Many serious side effects, however, are due to the prolonged use of budesonide or other steroids. 

How long do budesonide side effects last?

Mild side effects might improve over time, but it’s not guaranteed. Some will last as long as the drug is taken. Others, such as loss of bone density, weight gain, acne, cataracts, and glaucoma could worsen the longer budesonide is taken. Additionally, infections due to immune suppression may keep happening over and over again as long as the drug is being taken. 

Most side effects will improve when budesonide is discontinued. It takes a while, however, to stop taking budesonide. To prevent withdrawal, a steadily decreasing dose must be taken over several weeks. By the time the tapering is finished, many mild side effects will have gotten better. Some more serious side effects, like cataracts or osteoporosis, are longer-term problems that may require medical treatment.

What are the long-term side effects of budesonide?

Some of the most serious side effects of budesonide result from prolonged use of budesonide or other corticosteroids. These include:

  • Hypercorticism
  • Adrenal gland dysfunction
  • Immune system suppression
  • Cataracts
  • Osteoporosis
  • Growth suppression

People taking budesonide as a maintenance or long-term treatment for irritable bowel disease (IBD), asthma, or COPD, should discuss the long-term consequences with the prescriber.

Budesonide contraindications

Oral budesonide can never be taken by people with severe liver disease or allergies to budesonide or other corticosteroids.

Budesonide inhalants or nasal sprays are also never prescribed to people with budesonide or corticosteroid allergies. It is not appropriate to use budesonide inhalers to treat an asthma attack.

Pregnancy

When taken as a tablet or capsule during pregnancy, budesonide could cause birth defects or worse, especially during the first trimester. Oral budesonide is not prohibited during pregnancy, but the risks to the fetus will have to be weighed against the benefits of taking the drug.

There is not enough information to determine if inhaled budesonide or nasal spray is safe to take during pregnancy. Again, risks and benefits will have to be weighed against each other.

Breastfeeding

Budesonide is present in human breast milk but in small amounts. Healthcare professionals consider oral, inhaled, and nasal budesonide to be acceptably safe in breastfeeding mothers.

Children

Inhaled budesonide is FDA approved for use in children from the ages of 12 months to 8 years old. However, individual brand-name products may be approved for different age ranges. Budesonide capsules and tablets can be taken by children as young as 8 years old. The nasal spray can be used by children as young as 6 years old. The biggest worry is the effects of oral, inhaled, or nasal budesonide on a child’s growth, particularly when used for a prolonged time. Growth—both height and weight—should be monitored carefully when a child is taking budesonide.

Seniors

Dosage reductions are not required in people older than 65. However, healthcare providers will try to start with lower doses. 

Budesonide warnings

All corticosteroids can cause problems due to pre-existing conditions, overuse, or overdose. Budesonide is no exception, though it’s generally less worrisome when taken as an inhalant or nasal spray.

Cautions

Many of budesonide’s side effects can exacerbate existing medical conditions. Budesonide isn’t necessarily prohibited, but it may require dose adjustments or careful monitoring by a healthcare professional. These conditions include:

  • Weakened immune system
  • Diabetes (or a family history of diabetes)
  • High blood pressure
  • High pressure in the eye
  • High fluid pressure in the skull
  • Active infections
  • Active chickenpox, shingles, or measles infections or exposure to measles or varicella
  • A past tuberculosis infection
  • Osteoporosis 
  • Malnutrition
  • Cataracts
  • Glaucoma (or a family history of glaucoma)
  • Gastrointestinal perforation
  • Ulcers
  • Nasal trauma, surgery, sores, or perforation
  • Myasthenia gravis
  • Seizure disorders
  • Cushing’s syndrome

Abuse

Budesonide is not associated with drug abuse. 

Dependence and withdrawal

Like all corticosteroids, budesonide reduces or suppresses the body’s natural production of the hormone cortisol. This disrupts an entire complex of hormone production in the body. For this reason, the sudden discontinuation of budesonide or any other corticosteroid can produce unpleasant side effects like tiredness, weakness, muscle pain, nausea, headaches, dizziness, blurred vision, loss of appetite, weight loss, and other problems. When it’s time to stop taking budesonide, the doses should be tapered gradually.

Overdose

If too much budesonide is taken at one time, call a poison control center or get medical attention. 

Budesonide interactions

Budesonide has many different and powerful effects on the body, so it interacts with a number of prescription drugs, over-the-counter medications, and even dietary supplements. The list is very long, but the most important are:

  • Live vaccines. Budesonide is prohibited in anyone getting a live vaccine. Budesonide suppresses the immune systems, so vaccines containing weakened bacteria or viruses could potentially blow up into active and life-threatening infections.
  • Vaccines. Other vaccines are safe, but because budesonide weakens the immune system, they’re less effective.
    • Immune suppressants. Combining budesonide with immune suppressants weakens the immune system even further, leaving people more vulnerable to infections.
    • Other corticosteroids. Taking more than one corticosteroid increases the risk for side effects, particularly adrenal gland problems.
  • Drugs and foods that block the body’s metabolism of budesonide. Some substances tie up the liver enzyme that breaks down budesonide. As a result, budesonide builds up in the blood, increasing the risk for side effects. Healthcare providers are aware of these drugs and will adjust doses accordingly. Grapefruit and grapefruit juice are also in this category, so they should be avoided when taking budesonide.
  • Desmopressin. Used to treat frequent urination or bedwetting, desmopressin should never be combined with budesonide because of the risk of low blood sodium. Mifepristone is also contraindicated in anyone taking budesonide.

How to avoid budesonide side effects

Adverse effects are a fact of life when taking corticosteroids, but they’re not entirely unavoidable. Here are a few tips to keep budesonide side effects at arm’s length. 

1. Follow instructions

The first and best rule is to take budesonide exactly as instructed. Don’t take too much. Don’t take doses too frequently. If taking over-the-counter nasal spray, read the drug information carefully and follow all its directions.

2. Tell the prescriber about all medical conditions and medications

Some of budesonide’s most serious side effects involve making existing medical conditions worse. The prescriber should have a complete medical history that includes: 

  • Any active infection
  • Any past infection with tuberculosis
  • Exposure to measles or chickenpox
  • A weakened immune system
  • Stomach ulcers
  • High blood pressure
  • Diabetes
  • Thyroid problems
  • Osteoporosis or low bone mineral density
  • Myasthenia gravis
  • Liver problems
  • Pregnancy or pregnancy plans
  • Breastfeeding or any plans to breastfeed

3. Tell the prescriber about all medications being taken

Drug interactions are another common source of trouble when taking budesonide, so make sure the prescriber has a complete picture of all drugs and supplements being taken. When seeing any other healthcare provider, tell them about budesonide before they prescribe another drug.

4. Avoid grapefruit and grapefruit juice

Do not eat grapefruits or drink grapefruit juice throughout the duration of budesonide treatment. Grapefruit could increase the risk and severity of budesonide side effects.

5. Take calcium and vitamin D supplements

To avoid bone loss during prolonged budesonide treatment, take calcium and vitamin D supplements or eat foods rich in these two bone-healthy nutrients.

6. Avoid infections

Because budesonide weakens the immune system, take precautions to avoid getting an infection. Try to avoid people who are sick. Wear a face covering and keep your distance when in public.

7. Rinse out the mouth after taking a puff of budesonide inhalant

To prevent yeast infections of the mouth, rinse out the mouth with water and spit it out shortly after taking a puff of budesonide. 

8. Do not stop taking budesonide

To avoid withdrawal symptoms, do not stop taking budesonide until talking to the prescriber.

How to treat side effects of budesonide

If they do happen, some side effects can be handled at home. Others, however, may require medical attention.

Infection

Contact the prescriber if signs of an infection are noticed. It may be nothing, but because budesonide weakens the immune system, a healthcare professional should be aware of the infection.

Digestive system problems

Contact the prescriber if there’s any evidence of gastrointestinal problems such as stomach pain, black and tarry stools, bloody stools, vomiting, or blood in the vomit.

Hypercorticism

Tell the prescribing healthcare provider if problems emerge due to taking too much budesonide for too long including acne, unwanted hair growth, changes in the face’s shape, unexplained stretch marks on the skin, and easy bruising. The prescriber may need to adjust the dose.

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