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.
- 0.25-0.5 mg/day NEB divided QD-BID
- 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.
- 0.25-1 mg/day NEB divided QD-BID
- 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.
- 0.25-1 mg/day NEB divided QD-BID
- 1-8 yo with prior bronchodilator alone
- 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
- <11 yo: 1 mg PO QD x4-12 weeks
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.