Eosinophilic esophagitis (EOE) is a chronic inflammatory disorder where eosinophils (a type of white blood cell) build up in the lining of the esophagus. This accumulation causes inflammation, which can lead to difficulty swallowing and food impaction. Doctors often prescribe budesonide, a corticosteroid, to treat this localized inflammation. This topical delivery method, known as a budesonide slurry, is created by mixing the medication with a thickening agent to coat the esophageal tissue directly. This guide provides detailed instructions on how to correctly prepare and administer this slurry for effective, localized treatment.
Gathering the Necessary Supplies
Preparing the oral viscous budesonide begins with collecting all required materials to ensure the correct dosage and consistency. The primary component is the budesonide suspension, typically supplied in individual plastic vials called respules. Although intended for nebulization, these respules are swallowed for EOE treatment, and the specific dosage (e.g., 0.5 mg/2 mL or 1 mg/2 mL) is determined by a healthcare provider.
A thickening agent, or vehicle, is necessary to create the viscous texture. Common agents include sucralose powder packets, honey, maple syrup, or a teaspoon of applesauce. The thickening agent also masks the naturally bitter taste of the budesonide, making it more palatable. You will also need a small, clean mixing cup and a clean utensil for stirring to achieve a uniform consistency.
Step-by-Step Slurry Preparation Instructions
A single dose must be prepared immediately before administration to ensure the medication is fully suspended. Start by twisting the tab off the budesonide respule and pouring the entire liquid contents (usually 2 milliliters) into a clean mixing cup.
Next, add the prescribed amount of the chosen thickening agent to the cup. If using sucralose powder, the typical ratio involves mixing the respule contents with about four or five packets of sweetener. If using a food-based vehicle like applesauce, honey, or agave nectar, one teaspoon is the standard quantity to create the appropriate viscosity.
Using a clean spoon or utensil, stir the mixture vigorously until the medication and vehicle are completely combined. The final mixture should be thick enough to slowly coat the esophagus during swallowing, yet liquid enough to be swallowed easily without risk of choking. This viscous texture ensures prolonged contact with the inflamed tissue.
Proper Administration Technique
The technique for swallowing the slurry is paramount, as the goal is to coat the entire length of the esophagus. Once prepared, the slurry should be swallowed immediately and deliberately, rather than being gulped down. Swallowing slowly ensures the viscous mixture coats the esophageal lining, delivering the corticosteroid directly to the inflamed tissue.
Following ingestion, avoid eating or drinking any liquids for a set period, typically 30 to 60 minutes. This restriction prevents the medication from being washed down into the stomach prematurely, allowing the budesonide to remain in contact with the esophageal wall. If administering near a mealtime, take the slurry about 30 minutes before or after eating.
For young patients or those unable to manage a spoon, an oral syringe can be used to slowly administer the entire dose into the mouth. The entire dose must be consumed to receive the full therapeutic effect prescribed by the physician.
Important Storage and Safety Considerations
For optimal safety and efficacy, the budesonide slurry must be prepared immediately before each dose, and any unused portion must be discarded. The mixture does not have a stable shelf life. Prior to mixing, the liquid budesonide respules should be kept in their original packaging and stored away from excess heat and moisture, following the manufacturer’s instructions.
A significant safety concern with any swallowed topical corticosteroid is the risk of developing oral candidiasis, commonly known as thrush (a yeast infection of the mouth and throat). To mitigate this risk, patients must rinse their mouth and throat thoroughly with water immediately after swallowing the slurry. After swishing the water around the mouth, it is essential to spit out the rinse water rather than swallowing it.
If a dose is missed, follow the specific instructions provided by your healthcare provider. This usually involves taking the dose as soon as you remember, unless it is nearly time for the next scheduled dose. Never take a double dose to make up for a missed one. If symptoms of thrush, such as white spots or a sore throat, appear, contact the prescribing physician immediately. Consistent adherence to the prescribed dosing schedule and post-dosing hygiene is necessary for maintaining control over the chronic inflammation associated with EOE.