1. About budesonide rectal foam and enemas
Budesonide rectal foam and enemas are used to treat ulcerative colitis. These medicines are applied into your bottom (rectum).
Ulcerative colitis is a long-term condition where you get patches of swelling (inflammation), and sometimes ulcers, in the lining of your bowel. The most common symptoms are stomach (abdominal) pain and bloody diarrhoea.
Budesonide does not cure ulcerative colitis. However, it helps reduce symptoms by calming down the inflammation in your bowel.
The rectal foam and enemas are available on prescription only.
Budesonide also comes as an inhaler, a nasal spray, and tablets, capsules or granules for treating other conditions:
2. Key facts
- You'll usually use budesonide rectal foam or an enema once a day for 4 to 8 weeks.
- This helps with symptoms like stomach pain and bloody diarrhoea.
- For most people symptoms start to improve after 1 or 2 weeks.
- Using budesonide rectal foam or enemas can mean you're more likely to get infections. Tell your doctor if you get an infection, such as coronavirus (COVID-19), or if you come into contact with anyone who has shingles, chickenpox or measles while you're using budesonide.
3. Who can and cannot use budesonide rectal foam and enemas
Budesonide rectal foam and enemas can be used by adults (aged 18 years and over).
Budesonide is not suitable for some people. To make sure it's safe for you, tell your doctor before starting this medicine, if you:
- have had an allergic reaction to budesonide or any other medicine in the past
- have recently been in contact with someone with chickenpox, shingles or measles
- currently have an infection, or have very recently had one
- have any other problems with your bowel or rectum
- have ever had a stomach ulcer or ulcer in your intestines (duodenal ulcer)
- have ever had mental health problems, such depression or psychosis
- have high blood pressure
- have diabetes
- have liver problems
- have osteoporosis
- have ever had tuberculosis (TB)
- have glaucoma or a cataract
- have recently had vaccinations, or are due to have vaccinations
- are pregnant, trying to get pregnant or breastfeeding
4. How and when to use it
The usual dose of budesonide is 2mg, used once a day. Your doctor will tell you how long to use it for. This will usually be 6 to 8 weeks if you use the rectal foam, or 4 to 8 weeks for the enemas.
Always follow your doctor's instructions when using your medicine.
Budesonide rectal foam
Budesonide foam comes in a can with single-use plastic tubes (applicators). Each applicator holds a 2mg dose of foam.
Try to use it at about the same time of day, either in the morning or in the evening before bed.
Use the rectal foam after doing a poo. This is because the medicine works best when your bowels are empty.
After you apply the foam, try not to poo again for at least a few hours. For the medicine to work properly it needs to stay inside your bowel as long as possible.
How to use the foam
First read the instruction leaflet. The pictures show you exactly how to use the foam.
Before using it for the first time, remove the plastic flap (or safety lock) from underneath the dome-shaped pump at the top of the can.
- Wash your hands before and after using the foam.
- Push a new applicator onto the nozzle. This nozzle sticks out beneath the dome at the top of the can.
- Shake the can for about 15 seconds.
- There is a rounded gap at the base of the dome. Twist the dome until the gap lines up with the nozzle.
- Put your finger on top of the dome and turn the can upside down. It's important to keep the can as straight (vertical) as possible.
- Stand with one leg raised on a chair – or lie down on your side if you prefer. Gently put the tip of the applicator into your bottom as far as possible.
- Push the dome down. This fills the applicator with a dose of foam.
- Release the dome very slowly.
- Wait 10 to 15 seconds and then slowly remove the applicator from your bottom. Do not do this too quickly to prevent the foam coming out.
- Remove the applicator from the nozzle. Put it in the plastic bag provided and throw the bag away.
This medicine comes as liquid and tablets that you mix together. Once made up, the enema contains a 2mg dose of budesonide.
The usual dose is one enema every night.
It's best to go to the toilet before using the enema. This is because it's more comfortable if you empty your bowels and bladder before using it.
You may want to sleep on a towel or similar covering. This is to protect your bedding from stains.
How to prepare the enema
First read the instruction leaflet. The pictures show you exactly how to prepare and use the enema.
- Take a bottle of the liquid and unscrew the whole top section. Keep the nozzle and protective cap together. Do not separate them.
- Remove 1 tablet from the foil strip and drop it into the bottle of liquid.
- Replace the nozzle and protective cap and screw firmly back onto the bottle.
- Shake the bottle well for at least 15 seconds, or until the tablet has dissolved in the liquid.
How to use the enema
- Wash your hands before and after using the enema.
- Lie on your side, with your bottom slightly higher than the rest of your body. You can use a pillow to lift your bottom up. You may want to lie on a towel.
- Put one of the disposable plastic bags provided over your hand (like a glove) and pick up the bottle.
- Shake the bottle and remove the protective cap that covers the nozzle.
- Gently push the nozzle into your bottom as far as is comfortable.
- Squeeze the bottle to empty the liquid into your bottom. It's normal for some liquid to be left in the bottle afterwards.
- Remove the nozzle from your bottom.
- Put the bottle into the disposable plastic bag, ready to throw away.
- Roll onto your front and wait for 5 minutes. This will stop any liquid coming out of your bottom.
- For sleeping, find a comfortable position that keeps the liquid in your bottom for as long as possible. The longer it stays there, the better it will work.
What if I forget to use it?
If you forget to use your budesonide, use it as soon as you remember unless it's nearly time for the next dose. In this case skip the missed dose and take the next one at the usual time.
Never use a double dose.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to use this medicine.
What if I use too much?
Using too much budesonide by accident is unlikely to harm you.
If you're worried, talk to your doctor or a pharmacist.
5. Side effects
Like all medicines, budesonide can cause side effects, although not everyone gets them.
Common side effects
Common side effects happen in more than 1 in 100 people.
Tell your doctor if these side effects bother you or do not go away:
- feeling sick, indigestion and trapped wind
- burning or stinging around your bottom
Serious side effects
It's rare to get serious side effects with budesonide rectal foam or enemas.
This is because they are applied directly into the bowel and the medicine gets to where it's needed without affecting the rest of your body.
Sometimes budesonide can get through the lining of your bowel into your blood, meaning you are at higher risk of side effects. However, this is more likely to happen if you use it for a long time.
Tell a doctor straight away if you get:
- high temperature, chills, a very sore throat, ear or sinus pain, a cough, coughing up more mucus (phlegm) or a change in colour of your mucus, pain when you pee, mouth sores or a wound that will not heal – these can be signs of an infection
- "moon face" (a puffy, rounded face), weight gain in the upper back or belly – this happens gradually and can be a sign of Cushing's syndrome
- a very upset stomach or you're being sick (vomiting), very bad dizziness or passing out, muscle weakness, very tired, mood changes, loss of appetite and weight loss – these can be signs of adrenal gland problems
- changes in your eyesight, such as blurred vision or a cloudy lens in the eye – these can be signs of increased pressure in your eyes (glaucoma) or a cataract
- depressed or have thoughts about harming yourself, have mood swings (highs or lows), feel anxious, are seeing or hearing things that are not there or having strange or frightening thoughts – these can be signs of mental health problems
- severe stomach pain, severe back pain, a very upset stomach or you're being sick (vomiting) – these can be signs of pancreas problems
Serious allergic reaction
It is possible to have a serious allergic reaction (anaphylaxis) to budesonide.
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of budesonide. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
6. How to cope with side effects
What to do about:
- diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- feeling sick, indigestion and trapped wind – it may help if you stick to plain food and try eating smaller meals and more often. Tell your doctor if this problem does not go away. They may be able to prescribe an extra medicine to protect your stomach.
- burning or itching around your bottom – this is usually mild and only lasts a few days. Ask a pharmacist to recommend a cream if it bothers you. Tell your doctor if this does not go away after 1 week.
7. Pregnancy and breastfeeding
Budesonide and pregnancy
Budesonide rectal foam and enemas are not usually recommended when you're pregnant. This is because there's not enough information to know whether they're safe to use during pregnancy.
However, your doctor may prescribe budesonide rectal foam or enemas if they think this is the best treatment for you. Speak to your doctor if you have questions about your medicine.
Budesonide and breastfeeding
It's generally OK to use budesonide rectal foam and enemas while breastfeeding. However, you should always check with your doctor first.
Small amounts of budesonide can get into breast milk. Your baby may need extra monitoring if you use higher doses or if you are using it for a long time.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Some medicines and budesonide interfere with each other. This can increase your chance of getting side effects.
Check with a pharmacist or your doctor if you're taking:
- drugs used to treat HIV, such as ritonavir or cobicistat
- antifungal medicines, such as ketoconazole or itraconazole
- other medicines that contain steroids, such as eczema creams, tablets, injections, inhalers, nasal sprays, and eye or nose drops
Mixing budesonide with herbal remedies and supplements
There's very little information about taking herbal remedies and supplements while taking or using budesonide. Ask a pharmacist for advice.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How does it work?
Budesonide is a steroid (corticosteroid) medicine.
Steroids closely copy the effects of natural hormones produced in your adrenal glands. The adrenal glands are above your kidneys.
They work by calming down your immune system. This reduces inflammation in the lining of your bowel and bottom (rectum) and helps relieve symptoms like pain and bloody diarrhoea.
How long does budesonide take to work?
Budesonide does not work right away.
Your symptoms will usually start to improve within 1 or 2 weeks. It can take 2 to 4 weeks for the medicine to reach its full effect.
How long will I use it for?
You'll usually use the rectal foam or enemas for 4 to 8 weeks.
Your doctor will tell you how long to use budesonide for. Occasionally they may want you to use it for longer, or give you a repeat prescription.
Can I drink alcohol with it?
Yes, you can drink alcohol when using budesonide.
However, drinking alcohol can make the symptoms of ulcerative colitis worse.
Is there any food or drink I need to avoid?
Do not eat grapefruit or drink grapefruit juice while you're using budesonide. Grapefruit does not mix well with this medicine.
Apart from grapefruit, you can eat and drink normally while using budesonide.
However, if you have ulcerative colitis you may need to avoid certain foods to help your symptoms.
Read about living with ulcerative colitis for more advice.
Will it affect my contraception?
However, if you're having a flare-up of ulcerative colitis with diarrhoea, your body may not absorb oral contraceptive pills very well. Ask your doctor or a pharmacist about other contraception options.
Will it affect my fertility?
There is no clear evidence to suggest that using budesonide will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor if you're trying to get pregnant. This medicine is not usually recommended during pregnancy.
Can I drive or ride a bike?
For most people budesonide will not change their ability to drive a car or cycle.
However, if budesonide affects your eyesight in any way, do not drive, cycle or use tools or machinery.
Do I need to be careful of infections?
Using budesonide rectal foam or enemas makes you more likely to catch infections such as flu, coronavirus (COVID-19), the common cold and chest infections. Tell your doctor if you get symptoms of an infection or test positive for COVID-19.
Tell your doctor straight away if you come into contact with someone who has chickenpox, shingles or measles. Your doctor may be able to prescribe a medicine to protect you.
Can I still have vaccinations?
If you need any vaccinations, tell the doctor or nurse that you're using a steroid.
The injected flu vaccine is generally safe to have because this is an "inactive" vaccine.
However, there may be a problem with having "live" vaccines. These include:
- shingles vaccine
- BCG (tuberculosis) vaccine
- yellow fever vaccine
- MMR (measles, mumps and rubella) vaccine
- nasal spray flu vaccine
When you are using budesonide, your immune system might not be strong enough to handle a live vaccine. This could lead you to getting an infection.
Do I need a blue steroid card?
If you're on a high dose of steroids or need to take them for a long time, your pharmacist or doctor may give you a steroid treatment card. Carry this with you all the time. If you need any medical or dental treatment, show your blue steroid card to the doctor or dentist.
The card, which is usually blue, is the size of a credit card and fits in your wallet or purse. It tells you how to reduce the risks of steroid-related side effects. It also gives details of your doctor, your dose of budesonide and how long your treatment is expected to last.