budesonide

(bue des' oh nide)

Inhalation:
Entocort (CAN), Pulmicort Respules, Pulmicort Turbuhaler, Rhinocort Aqua, Rhinocort
Turbuhaler (CAN)
Oral:
Entocort EC

Pregnancy Category B

Drug class
Corticosteroid

Therapeutic actions
Anti-inflammatory effect; local administration into nasal passages maximizes
beneficial effects on these tissues, while decreasing the likelihood of adverse effects
from systemic absorption.

Indications

Management of symptoms of seasonal or perennial allergic rhinitis in adults

and children; nonallergic perennial rhinitis in adults
Turbuhaler

Maintenance treatment of asthma as prophylactic therapy in adults and

children > 6 yr and for patients requiring corticosteroids for asthma
Inhalation suspension

Maintenance treatment and prophylaxis therapy of asthma in children 12 mo

8 yr
Oral


Treatment of mild to moderate active Crohn's disease involving the ileum or
ascending colon

Contraindications and cautions

Inhalation

Contraindicated with hypersensitivity to drug or for relief of acute asthma or

bronchospasm.

Use cautiously with TB, systemic infections, lactation.

Oral

Contraindicated with hypersensitivity to drug, lactation.

Use cautiously with TB, hypertension, diabetes mellitus, osteoporosis, peptic

ulcer disease, glaucoma, cataracts, family history of diabetes or glaucoma, other
conditions in which glucocorticosteroids may have unwanted effects.
Nasal

Contraindicated with hypersensitivity to drug, nasal infections, nasal trauma,

nasal septal ulcers, recent nasal surgery.

Use cautiously with lactation, TB, systemic infection.

Available forms
Aerosol32 mcg/actuation; dry powder for inhalation200 mcg (each actuation
delivers 160 mcg); inhalation suspension0.25 mg/2 mL, 0.5 mg/2 mL; capsules3
mg

Dosages
Nasal inhalation
ADULTS AND PATIENTS > 6 YR
Initial dose, 64 mcg/day given as 1 spray in each nostril morning and evening. After
desired clinical effect is achieved, reduce dose to the smallest dose possible to
maintain the control of symptoms. Generally takes 37 days to achieve maximum
clinical effect.

Pulmicort Turbuhaler
ADULTS
Previously on inhaled corticosteroids: Initially, 200400 mcg twice daily, maximum
dose, 800 mcg bid (4 inhalations).
Previously on bronchodilators alone: 200400 mcg bid.
Previously on oral corticosteroids: 400800 mcg bid.
PEDIATRIC PATIENTS
Children > 6 yr previously on inhaled corticosteroids: 200 mcg bid.
Children > 6 yr previously on bronchodilators alone: 200 mcg bid.
Children > 6 yr previously on oral corticosteroids: 400 mcg bid.

Respules
PEDIATRIC PATIENTS 12 MO8 YR
0.251 mg once daily or in two divided doses of Respules, using jet nebulizer.
Oral
ADULTS
9 mg/day PO taken in the morning for up to 8 wk. Recurrent episodes may be
retreated for 8-wk periods.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Monitor patients very closely for signs of hypercorticism; reduced dosage should be
considered with these patients.

Pharmacokinetics
Route

Onset
Peak
Duration
Intranasal, inhaled
Immediate
Rapid
812 hr
Oral
Slow
0.510 hr
Unknown
Metabolism: Hepatic; T1/2: 23.6 hr (oral); T1/2: 2.8 hr (inhalation)
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse effects

CNS: Headache, dizziness, lethargy, fatigue, paresthesias, nervousness

Dermatologic: Rash, edema, pruritus, alopecia

Endocrine: HPA suppression, Cushing's syndrome with overdosage and

systemic absorption

GI: Nausea, dyspepsia, dry mouth

Local: Nasal irritation, fungal infection

Respiratory: Epistaxis, rebound congestion, pharyngitis, cough

Other: Chest pain, asthenia, moon face, acne, bruising, back pain

Interactions
Oral use

Drug-drug

Increased risk of corticosteroid toxic effects if combined with ketoconazole,

itraconazole, ritonavir, indinavir, saquinavir, erythromycin, or other known CYP3A4
inhibitors; if drugs must be used together, decrease dosage of budesonide and
monitor patient closely
Drug-food

Risk of increased toxic effects if combined with grapefruit juice; avoid this
combination.

Nursing considerations
Assessment

History: Untreated local nasal infections, nasal trauma, septal ulcers, recent
nasal surgery, lactation

Physical: BP, P, auscultation; R, adventitious sounds; examination of nares

Interventions
Inhalation

WARNING: Taper systemic steroids carefully during transfer to inhalational

steroids; deaths from adrenal insufficiency have occurred.

Arrange for use of decongestant nose drops to facilitate penetration if edema,

excessive secretions are present.

Prime unit before use for Pulmicort Turbuhaler; have patient rinse mouth after
each use.

Use aerosol within 6 mo of opening. Shake well before each use.

Store Respules upright and protected from light; gently shake before use;
open envelopes should be discarded after 2 wk.

Oral

Make sure patient does not cut, crush, or chew capsules; they must be
swallowed whole.


Administer the drug once each day, in the morning; do not administer with
grapefruit juice.

Encourage patient to complete full 8 wk of drug therapy.

WARNING: Monitor patient for signs of hypercorticismacne, bruising, moon

face, swollen ankles, hirsutism, skin striae, buffalo humpwhich could indicate need
to decrease dosage.

Teaching points
Inhalation

Do not use more often than prescribed; do not stop without consulting your
health care provider.

It may take several days to achieve good effects; do not stop if effects are not
immediate.

Use decongestant nose drops first if nasal passages are blocked.

Prime unit before use for Pulmicort Turbuhaler; rinse mouth after each use.

Store Respules upright, protect from light; discard open envelopes after 2 wk;
gently shake before use.

You may experience these side effects: Local irritation (use your device
correctly), dry mouth (suck sugarless lozenges).

Report sore mouth, sore throat, worsening of symptoms, severe sneezing,

exposure to chickenpox or measles, eye infections.

Oral

Take the drug once a day in the morning. Do not cut, crush, or chew the
capsules, they must be swallowed whole.

If you miss a day, take the capsules as soon as you remember them. Take the
next day's capsules at the regular time. Do not take more than three capsules in a
day.

Take the full course of the drug therapy (8 wk in most cases).

Do not take this drug with grapefruit juice; avoid grapefruit juice entirely while
using this drug.


Store Respules upright, protected from light; discard open envelopes after 2
wk. Shake before use.

You may experience these side effects: Dizziness, headache (avoid driving or
operating dangerous machinery if these effects occur); nausea, flatulence (frequent
small meals may help; try to maintain your fluid and food intake).

Report chest pain, ankle swelling, respiratory infections, increased bruising.