Budesonide (BUD) is a medication of the corticosteroid type. It is available as an inhaler, pill, nasal spray, and rectal forms. The inhaled form is used in the long-term management of asthma and chronic obstructive pulmonary disease (COPD). The nasal spray is used for allergic rhinitis and nasal polyps. The pills in a delayed release form and rectal forms may be used for inflammatory bowel disease including Crohn’s disease, ulcerative colitis and microscopic colitis.
Class of Drug
Mechanism of Action
Inhibits elaboration of many of the mediators of allergic inflammation, eg, leukotrienes and other products of the arachidonic acid cascade.
Indications / Dosage / Route
Routes of Administration: Inhalation aerosol.
Dose: Adults: 200-800 μg b.i.d. (1-4 inhalations morning and evening).
Children: >6 years: 200-100 μg b.i.d. (1-2 inhalations, morning and evening).
Condition: Seasonal or perennial rhinitis
Dose: Adults: children >6 years: Initial: 256 μig/d, 2 sprays in each nostril in morning and evening. Maintenance: reduce initial dose to smallest amount necessary to control symptoms.
Adjustment of Dosage
Kidney disease: None.
Liver disease: None.
Pediatric: Safety and efficacy have not been established in children <6 years.
Food and Drug Interactions
Pregnancy: Category C.
Lactation: Present in breast milk. Safe to use.
Contraindications: Hypersensitivity to corticosteroids.
Warnings / Precautions
> If patient is transferred from systemic corticosteroid to inhalation drug, symptoms of steroid withdrawal may result. These include muscle and joint pain, depression. Alternatively, adreneal insufficiency may occur: weakness, fatigue, nausea, anorexia.
> Provide patient with instructions for use of the inhaler or nasal spray and make sure patient completely understands these instructions.
> Provide patient with a list of side effects and note those that require immediate reporting to the physician.
> Patients on long-term inhaled or intranasal corticosteroids may require steroid pulsing during stress, eg, surgery or infection.
Clinically Important Drug Interactions
> Common: pharyngitis, headache.
> Serious: potential for hypercorticism, adrenal insufficiency.
Parameters to Monitor
> Signs and symptoms of acute adrenal insufficiency, particularly in response to stress.
> Child growth: Drug may suppress growth.
> Changes in nasal mucosa in patients on long-term drug therapy.
> Signs of localized infection in mouth and pharynx, eg, red membranes with vesicular eruptions. Treat with appropriate antifungal drug, eg, nystatin, or discontinue treatment.
> When switching from systemic inhalation therapy, monitor patient for symptoms of adrenal insufficiency: hypotension, weight loss, muscular and joint pain. If these occur, the dose of systemic steroid should be increased followed by slower withdrawal. It may require up to 12 months for HPA function to fully recover.
Advice to Patient
> Rinse mouth and gargle with warm water after each inhalation. This may minimize the development of dry mouth, hoarseness, and oral fungal infection.
> This drug should be inhaled 5 minutes after a previously inhaled bronchodilator, eg, albuterol.
> Do not exceed recommended dosage of the drug. Excessive doses have been associated with adrenal insufficiency.
> Notify physician if symptoms worsen.
> Carry a card indicating your condition, drugs you are taking, and need for supplemental steroid in the event of a severe asthmatic attack. Attempt to decrease dose once the desired clinical effect is achieved. Decrease dose gradually every 2-4 weeks. Return to initial starting dose if symptoms recur.
> Stop smoking.
> Do not overuse the inhaler.
Further Useful Info
> Inhaled corticosteroids are the drugs of choice for patients with refractory symptoms on prn adrenergic agonist bronchodilators.
> Inhalation steroids are useful in reducing the dose or discontinuing use of oral corticosteroids. However, there is considerable controversy with respect to the beneficial use of higher than recommended inhalation doses of these drags.