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-inIlammatory eIIect; local administration into nasal passages maximizes beneIicial eIIects
on these tissues, while decreasing the likelihood oI adverse eIIects Irom systemic absorption.

Indications
O Management oI symptoms oI seasonal or perennial allergic rhinitis in adults and
children; nonallergic perennial rhinitis in adults
Turbuhaler
O Maintenance treatment oI asthma as prophylactic therapy in adults and children ~ 6
yr and Ior patients requiring corticosteroids Ior asthma
Inhalation suspension
O Maintenance treatment and prophylaxis therapy oI asthma in children 12 mo8 yr
Oral
O Treatment oI mild to moderate active Crohn's disease involving the ileum or
ascending colon

Contraindications and cautions
Inhalation
O Contraindicated with hypersensitivity to drug or Ior relieI oI acute asthma or
bronchospasm.
O Use cautiously with TB, systemic inIections, lactation.
Oral
O Contraindicated with hypersensitivity to drug, lactation.
O Use cautiously with TB, hypertension, diabetes mellitus, osteoporosis, peptic ulcer
disease, glaucoma, cataracts, Iamily history oI diabetes or glaucoma, other conditions in
which glucocorticosteroids may have unwanted eIIects.
Nasal
O Contraindicated with hypersensitivity to drug, nasal inIections, nasal trauma, nasal
septal ulcers, recent nasal surgery.
O Use cautiously with lactation, TB, systemic inIection.

Available Iorms
Aerosol32 mcg/actuation; dry powder Ior 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. AIter desired
clinical eIIect is achieved, reduce dose to the smallest dose possible to maintain the control oI
symptoms. Generally takes 37 days to achieve maximum clinical eIIect.
Pulmicort Turbuhaler
ADULTS
!reviously on inhaled corticosteroids. Initially, 200400 mcg twice daily, maximum dose,
800 mcg bid (4 inhalations).
!reviously on bronchodilators alone. 200400 mcg bid.
!reviously 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 oI Respules, using jet nebulizer.
Oral
ADULTS
9 mg/day PO taken in the morning Ior up to 8 wk. Recurrent episodes may be retreated Ior 8-wk
periods. Maintenance treatment, 6 mg/day PO Ior up to 3 mo, then taper until cessation is
complete.
PEDIATRIC PATIENTS
SaIety and eIIicacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Monitor patients very closely Ior signs oI 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
etabolism: Hepatic; T
1/2
: 23.6 hr (oral); T
1/2
: 2.8 hr (inhalation)
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse eIIects
O $: eadache, di::iness, lethargy, fatigue, paresthesias, nervousness
O Dermatologic: Rash, edema, pruritus, alopecia
O Endocrine: HPA suppression, Cushing's syndrome with overdosage and systemic
absorption
O : Nausea, dyspepsia, dry mouth
O ocal: asal irritation, Iungal inIection
O #espiratory: Epistaxis, rebound congestion, pharyngitis, cough
O ther: Chest pain, asthenia, moon Iace, acne, bruising, back pain

Interactions
Oral use
Drug-drug
O Increased risk oI corticosteroid toxic eIIects iI combined with ketoconazole,
itraconazole, ritonavir, indinavir, saquinavir, erythromycin, or other known CYP3A4
inhibitors; iI drugs must be used together, decrease dosage oI budesonide and monitor
patient closely
Drug-Iood
O Risk oI increased toxic eIIects iI combined with grapeIruit juice; avoid this
combination.

Nursing considerations
Assessment
O istory: Untreated local nasal inIections, nasal trauma, septal ulcers, recent nasal
surgery, lactation
O !hysical: BP, P, auscultation; R, adventitious sounds; examination oI nares

Interventions
Inhalation
O #: Taper systemic steroids careIully during transIer to inhalational
steroids; deaths Irom adrenal insuIIiciency have occurred.
O Arrange Ior use oI decongestant nose drops to Iacilitate penetration iI edema,
excessive secretions are present.
O Prime unit beIore use Ior !ulmicort Turbuhaler, have patient rinse mouth aIter each
use.
O Use aerosol within 6 mo oI opening. Shake well beIore each use.
O Store Respules upright and protected Irom light; gently shake beIore use; open
envelopes should be discarded aIter 2 wk.

Oral
O Make sure patient does not cut, crush, or chew capsules; they must be swallowed
whole.
O Administer the drug once each day, in the morning; do not administer with grapeIruit
juice.
O Encourage patient to complete Iull 8 wk oI drug therapy.
O #: Monitor patient Ior signs oI hypercorticismacne, bruising, moon
Iace, swollen ankles, hirsutism, skin striae, buIIalo humpwhich could indicate need to
decrease dosage.

Teaching points
Inhalation
O Do not use more oIten than prescribed; do not stop without consulting your health
care provider.
O It may take several days to achieve good eIIects; do not stop iI eIIects are not
immediate.
O Use decongestant nose drops Iirst iI nasal passages are blocked.
O Prime unit beIore use Ior !ulmicort Turbuhaler, rinse mouth aIter each use.
O Store Respules upright, protect Irom light; discard open envelopes aIter 2 weeks;
gently shake beIore use.
O You may experience these side eIIects: Local irritation (use your device correctly),
dry mouth (suck sugarless lozenges).
O Report sore mouth, sore throat, worsening oI symptoms, severe sneezing, exposure to
chickenpox or measles, eye inIections.

Oral
O Take the drug once a day in the morning. Do not cut, crush, or chew the capsules,
they must be swallowed whole.
O II 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.
O Take the Iull course oI the drug therapy (8 weeks in most cases).
O Do not take this drug with grapeIruit juice; avoid grapeIruit juice entirely while using
this drug.
O Store Respules upright, protected Irom light; discard open envelopes aIter 2 weeks.
Shake beIore use.
O You may experience these side eIIects: Dizziness, headache (avoid driving or
operating dangerous machinery iI these eIIects occur); nausea, Ilatulence (Irequent small
meals may help; try to maintain your Iluid and Iood intake).
O Report chest pain, ankle swelling, respiratory inIections, increased bruising.

Adverse eIIects in talic are most common; those in old are liIe-threatening.