Switching from Budesonide to Prednisone

[Sorphal79]

I have been on Entrocort for 5 months and now Uceris for one month. My doctor is considering Prednisone next.

I know we would normally do a slow taper off the Budesonide but if I am switching straight to Prednisone, do I still need to taper the Uceris first?

[tex]

Cortisteroids (including budesonide and Uceris) all have a lingering effect that slowly decays. So yes you would either need to allow time for the Uceris to decay, or adjust the Prednisone dose to offset it. Your doctor should be aware of the best way to handle the switch.

We had one member a few years ago whose doctor didn't allow for the budesonide, and the prednisone he prescribed was a huge overdose that caused major problems for the patient.

Tex

[Sorphal79]

Thank you, Tex!

Have you heard of the best way to handle the tapering off of Uceris? Since it is a 9 mg pill, I thought this might be a bit tricky. I read an article that said something like skipping one day and then taking for two days, then skipping another... something like that.

I know my doctor will let me know how to handle it but I always like to get other opinions beforehand so I know what to expect.

[tex]

Now that you bring it up, there may not be a need to taper with Uceris, because it has no systemic action. That is , according to the manufacturer, none of it gets in your bloodstream. You're probably good to go if it's been at least a month or two since you've taken any budesonide. Your doctor is surely aware of the difference in the safety requirements for those two drugs (budesonide and Uceris), and I'll bet he will agree that the Uceris has no carryover effect.

I must have had my mind on something else when I wrote my previous post, because that only applies to budesonide (not Uceris). Sorry for misleading you.

Tex

[Sorphal79]

Now I am officially confused. I thought Uceris was Budesonide? And that the only difference between that and Enterocort (the more common form of Budesonide) was where it gets released. From what I gathered, Uceris is Budesonide that begins its release in the colon whereas, Enterocort Budesonide starts its release in the small intestine. At least, this is what I have been informed.

I certainly hope Uceris does contain Budesonide because I never weaned off of the Enterocort. I just went straight to Uceris. Hopefully that didn't do any kind of damage. My doctor didn't tell me taper from that one.

[tex]

You're correct, Uceris is budesonide, but the budesonide is encapsulated differently so that it gets released in the distal colon (toward the end of the colon). Uceris was developed primarily to treat UC, because UC starts in the distal colon. Ordinary budesonide is released so that the entire colon and the terminal ileum is treated. Because some is released upstream of the colon, up to about 19 % (according to published research) is absorbed by the bloodstream, so that the corticosteroid effects eventually become systemic. None of the budesonide in Uceris is absorbed into the bloodstream, so none of it can have any systemic effect. And yes, it's safe to switch either way between Uceris and budesonide, because the dose is equivalent.

I hope that un-confuses you.

Tex

[Sorphal79]

Would it have been more beneficial for me to taper the Budesonide first then, before switching over to the Uceris?

[tex]

Not as far as I'm aware.

Tex