budesonide

(bue des' oh nide)

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

Pregnancy Category C

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
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
Turbuhaler
• Maintenance treatment of asthma as prophylactic therapy in adults and children >
6 yr and for patients requiring corticosteroids for asthma

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
Aerosol—32 mcg/actuation; dry powder for inhalation—200 mcg (each actuation
delivers 160 mcg); inhalation suspension—0.25 mg/2 mL, 0.5 mg/2 mL; capsules—3 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 3–7 days to achieve maximum clinical effect.

Pulmicort Turbuhaler
ADULTS
Previously on inhaled corticosteroids: Initially, 200–400 mcg twice daily, maximum
dose, 800 mcg bid (4 inhalations).
Previously on bronchodilators alone: 200–400 mcg bid.
Previously on oral corticosteroids: 400–800 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 MO–8 YR
0.25–1 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, Immediate Rapid 8–12 hr
inhaled
Oral Slow 0.5–10 hr Unknown
Metabolism: Hepatic; T1/2: 2–3.6 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; exam of nares

Interventions
Inhalation
• 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.
• Monitor patient for signs of hypercorticism—acne, bruising, moon face, swollen
ankles, hirsutism, skin striae, buffalo hump—which 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.
• These side effects may occur: 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.
• These side effects may occur: Dizziness, headache (avoid driving or operating
dangerous machinery if these effects occur); nausea, flatulence (eat small,
frequent meals; try to maintain your fluid and food intake).
• Report chest pain, ankle swelling, respiratory infections, increased bruising.