Budesonide

Administration

• Type: Inhaled corticosteroid
• Dosage Forms: 3 DR
• Routes of Administration: Inhaled
• Common Trade Names: Pulmicort

Adult Dosing

• 1.5-2 mg NEB q 6 hr
  • Do not mix with other nebulized medications and rinse mouth after use

Pediatric Dosing

• Asthma maintenance
  • 1-8 yo with prior bronchodilator alone
    • 0.25-0.5 mg/day NEB divided QD-BID
      • Start: 0.5 mg/day
      • Max: 0.5 mg/day. Titrate to lowest effective dose.
  • 1-8 yo with prior inhaled steroid
    • 0.25-1 mg/day NEB divided QD-BID
      • Start: 0.5mg/day
      • Max: 1 mg/day. Titrate to lowest effective dose.
  • 1-8 yo with prior oral steroid
    • 0.25-1 mg/day NEB divided QD-BID
      • Start: 1 mg/day
      • Max: 1 mg/day. Titrate to lowest effective dose. Taper oral steroid gradually after >1 week.
• Eosinophilic esophagitis
  • <11 yo: 1 mg PO QD x4-12 weeks
    • Mix 1 mg/2mL NEB with 5 g sucralose to form PO slurry.
    • Avoid food/drink x30 min after each dose
  • 11+ yo: 2 mg PO QD x4-12 weeks
    • Mix 2 mg/4mL NEB with 10 g sucralose to form PO slurry.
    • Avoid food/drink x30 min after each dose

Special Populations

• Pregnancy Rating: B; drug of choice for pregnant patients with persistent asthma
• Lactation risk: L3; Safety unknown
• Renal dosing: not defined
• Hepatic dosing: not defined, monitor closely

Contraindications

• Allergy to class/drug
• Asthma, acute
• Acute asthma exacerbation
• Bronchospasm, acute
• Avoid abrupt withdrawal

Adverse Reactions

Serious

• Anaphylaxis
• Bronchospasm
• Hypersensitivty reaction, incl. rash
• Angioedema
• Adrenal suppression
• Cushing syndrome
• Hypercorticism
• Growth suppression
• Eosinophilia
• Churg-Strauss syndrome
• Glaucoma
• Cataracts
• Osteoporosis

Common

• [Upper respiratory infection]]
• Rhinitis
• Cough
• Otitis media
• Viral infection
• Candidiasis, oral
• Gastroenteritis
• Vomiting
• Diarrhea
• Abdominal pain
• Epistaxis
• Conjunctivitis
• Rash

Pharmacology

• Half-life: 2.3 hr
• Metabolism: Liver; CYP450: 3A4 substrate
• Excretion: Urine 60%, feces

Mechanism of Action

Inhibits multiple inflammatory cytokines and produces multiple glucocorticoid and mineralcorticoid effects. Exact mechanism unknown.