What You Need to Know About Budesonide Side Effects

Budesonide is a corticosteroid prescribed for conditions ranging from Crohn's disease and ulcerative colitis to asthma and allergic rhinitis. While it's generally better tolerated than stronger steroids like Prednisone, it still comes with side effects you should know about.

This guide covers the most common side effects, the serious ones to watch for, and exactly when you should call your doctor. If you're new to this medication, you may also want to read our overview of what Budesonide is and how it's used.

What Is Budesonide?

Budesonide is a synthetic corticosteroid that reduces inflammation in your body. It's available under several brand names — Entocort EC and Ortikos (oral capsules for Crohn's disease), Uceris (tablets for ulcerative colitis), Pulmicort (inhaler and nebulizer solution for asthma), Rhinocort (nasal spray for allergies), and Tarpeyo (for IgA nephropathy).

Because Budesonide is designed to work locally — in the gut, lungs, or nasal passages — it causes fewer whole-body side effects than systemic steroids. But "fewer" doesn't mean "none." Here's what to expect.

Common Side Effects

These side effects are reported frequently in clinical trials and FDA labeling. Most are mild and may improve as your body adjusts to the medication:

• Headache — one of the most commonly reported side effects across all formulations
• Nausea — especially with oral forms
• Upper respiratory infection — sore throat, runny nose, cold-like symptoms
• Back pain
• Joint pain
• Diarrhea or constipation
• Abdominal pain or bloating — more common with oral capsules and tablets
• Dizziness
• Acne
• Mood changes — irritability, anxiety, or feeling "wired"
• Insomnia — difficulty falling or staying asleep

For inhaled Budesonide (Pulmicort):

• Oral thrush (white patches in the mouth) — caused by the medication depositing in the throat. Rinsing your mouth after each use helps prevent this.
• Hoarseness or voice changes
• Cough

For nasal spray (Rhinocort):

• Nasal irritation, dryness, or burning
• Nosebleeds
• Sneezing after application

Serious Side Effects

These are less common but require medical attention. Contact your doctor right away if you experience any of the following:

• Adrenal suppression or insufficiency — If you take Budesonide for a long time (especially oral forms), your body may produce less cortisol on its own. Symptoms include extreme fatigue, weakness, dizziness, nausea, and low blood pressure. This is especially dangerous if you stop the medication suddenly without tapering.
• Signs of infection — Budesonide suppresses your immune system. Watch for fever, chills, persistent sore throat, painful urination, or wounds that won't heal. Corticosteroids can mask the symptoms of infection, so even mild symptoms deserve attention.
• Cushing syndrome symptoms — moon face (round, puffy face), weight gain in the trunk, thin skin, easy bruising, and stretch marks. These suggest too much corticosteroid activity in your body.
• Bone density loss — Long-term use can lead to osteoporosis. You may not notice symptoms until a fracture occurs. Your doctor may monitor bone density if you're on Budesonide for an extended period.
• Eye problems — Increased risk of glaucoma and cataracts, particularly with inhaled and nasal forms. Report any changes in vision, eye pain, or halos around lights.
• Severe allergic reaction — Rash, hives, swelling of the face/tongue/throat, difficulty breathing. This is rare but requires emergency medical care.
• High blood sugar — Corticosteroids can raise blood glucose levels. If you have diabetes or are at risk, monitor your blood sugar more closely while taking Budesonide.
• Liver problems — Rare, but report symptoms like yellowing of the skin or eyes, dark urine, or severe abdominal pain.

Side Effects in Specific Populations

Children

Budesonide (Pulmicort Respules) is approved for children as young as 12 months for asthma. The main concern in children is growth suppression. Long-term use of inhaled corticosteroids can slow growth velocity, although the effect is usually small (about 1 cm in the first year). Pediatricians should monitor height regularly.

Pregnant Women

Inhaled Budesonide is considered the preferred inhaled corticosteroid during pregnancy for asthma management. Oral Budesonide is Category C — meaning it should be used only if the benefit outweighs the risk. Always discuss with your OB/GYN.

Older Adults

Elderly patients may be more susceptible to bone density loss, high blood sugar, and infections. No dose adjustment is required, but closer monitoring is recommended.

People With Liver Disease

Oral Budesonide is extensively metabolized by the liver. If you have moderate-to-severe liver disease, more of the drug reaches your bloodstream, increasing the risk of systemic side effects. Your doctor may use a lower dose or choose a different medication.

How to Manage Budesonide Side Effects

Here are practical steps to minimize side effects:

• Rinse your mouth after using inhaled Budesonide to prevent oral thrush and hoarseness.
• Take oral Budesonide in the morning to reduce insomnia.
• Don't stop suddenly. If you've been on oral Budesonide for more than a few weeks, your doctor will have you taper the dose gradually to avoid adrenal insufficiency.
• Avoid grapefruit juice while taking oral Budesonide — it increases drug levels in your blood. Learn more in our guide to Budesonide drug interactions.
• Stay up to date on vaccines before starting Budesonide, but avoid live vaccines while on it.
• Get regular check-ups. Your doctor may monitor bone density, blood sugar, eye health, and growth (in children) during long-term treatment.
• Report new symptoms promptly. Even mild changes can be important when you're on a corticosteroid.

When to Call Your Doctor

Call your doctor if you experience:

• Signs of infection (fever, chills, persistent sore throat)
• Extreme fatigue or weakness (possible adrenal insufficiency)
• Vision changes
• Unexplained weight gain, moon face, or easy bruising
• Mood changes that feel unmanageable
• Blood sugar spikes (if you monitor glucose)

Call 911 or go to the ER if you have signs of a severe allergic reaction — difficulty breathing, swelling of the face or throat, or severe dizziness.

Final Thoughts

Budesonide is effective and generally well-tolerated, especially compared to systemic steroids like Prednisone. But it's still a corticosteroid, and side effects are possible — particularly with long-term use or higher doses.

The key is to know what to watch for and stay in communication with your doctor. If you're concerned about side effects, don't stop the medication on your own — talk to your provider about adjusting your dose or exploring alternatives.

If you need to fill a Budesonide prescription, Medfinder can help you find it in stock near you.