Tapering budesonide capsules

I am not a doctor. I am not a pharmacist. This is not medical advice.

We’ve learned a few things about tapering the Mylan 3 mg extended release budesonide capsules. These capsules are designed to deliver a steroid dose to the intestines. These are a generic of Entocort EC.

We don’t have experience with other brands, because we have stuck with one brand (Mylan). We have heard that different brands may tend to release the medication at different points in the intestines due to different coating formulations, so once we started on one brand, we stuck with that brand for consistency.

Some amount of the steroid has systemic effects, not just local effects. That can make it important to taper carefully.

After a number of failed attempts to taper the dose of 3x 3 mg capsules (9 mg total) by dropping to 2 capsules, by dropping to 2 capsules every other day, or even by dropping to 2 capsules every several days, the doctor suggested we might have to use a compounding pharmacy to taper in smaller increments.

It turns out that the capsules are easy to open, and each capsule typically contains 20-21 tiny pellets. The outer capsules dissolve quickly in the stomach, and the pellets are what actually have a coating to delay the release of the budesonide until further down in the digestive tract. That means that it is possible to open a capsule, remove any number of pellets, close it back up, and taper your budesonide dose in as little as 0.15 mg increments instead of 3.0 mg increments. That allows for a much slower and more gentle taper when that turned out to be necessary.

Empty gelatin capsules are available from Amazon if you want to put pellets into new capsules, rather than just discard the extra pellets.