bu·des·o·nide (by -d s  -n d )n. A corticosteroid used in inhalant form to treat asthma. |
budesonide,
budesonide (byōōdes´ōnīd´),
drug class: corticosteroid, synthetic;
action: interacts with steroid cytoplasmic receptors to induce antiinflammatory effects;
uses: management of symptoms of allergic rhinitis in adults and children; perennial nonallergic rhinitis in adults.
budesonide
Budenofalk (UK), Entocort EC, Pulmicort Respules, Pulmicort Turbuhaler, Rhinocort Aqua
Pharmacologic class: Corticosteroid (inhalation)
Therapeutic class: Antiasthmatic, steroidal anti-inflammatory
Pregnancy risk category C
FDA Boxed Warning
• Pulmicort Respules is meant only for inhalation by compressed air-driven jet nebulizers (not ultrasonic devices). It must not be injected. Read patient instructions before using.
Action
Decreases inflammation by inhibiting migration of inflammatory mediators to injury site, where it reverses dilation and increases vessel permeability. Also decreases plasma exudation and mucus secretions within airway.
Availability
Capsules (extended-release): 3 mg
Inhalation powder: 200 mcg/metered inhalation in 200-metered-dose inhaler
Inhalation suspension (Respules): 0.25 mg/2 ml, 0.5 mg/2 ml
Nasal spray: 32 mcg/metered spray (7-g canister)
⊘Indications and dosages
➣ Prophylactic therapy in chronic asthma
Adults previously controlled on bronchodilators alone: One or two inhalations b.i.d. (200 mcg/inhalation)
Adults previously controlled on other inhaled corticosteroids: One or two inhalations b.i.d. Maximum dosage is 800 mcg (four inhalations) b.i.d.
Adults previously controlled on oral corticosteroids: Two to four inhalations b.i.d. Maximum dosage is 800 mcg (four inhalations) b.i.d.
Children ages 6 and older: One inhalation (200 mcg) b.i.d. to a maximum of 400 mcg b.i.d.
Children ages 3 to 6 previously controlled on bronchodilators alone: One or two inhalations b.i.d. (200 mcg/inhalation)
Children ages 3 to 6 previously controlled on other inhaled corticosteroids: One or two inhalations b.i.d.
Children ages 3 to 6 previously controlled on oral corticosteroids: Maximum of two inhalations b.i.d.
Pulmicort Respules -
Children ages 12 months to 8 years previously controlled on bronchodilators alone: 0.25 mg/day as a single dose or in divided doses b.i.d.
Children ages 12 months to 8 years previously controlled on other inhaled corticosteroids: 0.5 mg/day as a single dose or in divided doses of 0.25 mg b.i.d.
Children ages 12 months to 8 years previously controlled on oral corticosteroids: 1 mg/day as a single dose or in divided doses b.i.d. Individualized titration is required.
➣ Seasonal or perennial allergic rhinitis
Adults and children ages 6 and older: Two sprays in each nostril in morning and evening, or four sprays in each nostril in morning. Maintenance dosage is fewest number of sprays needed to control symptoms.
➣ Mild to moderate active Crohn's disease involving ileum, ascending colon, or both
Adults: 9 mg P.O. daily for up to 8 weeks. For recurring episodes of active Crohn's disease, 8-week course can be repeated and tapered to 6 mg P.O. daily for 2 weeks before complete cessation.
Dosage adjustment
• Moderate to severe hepatic disease
Contraindications
• Hypersensitivity to drug
• Status asthmaticus
Precautions
Use cautiously in:
• renal disease, hepatic disease, heart failure, active untreated infections, systemic infections, hypertension, osteoporosis, diabetes mellitus, glaucoma, underlying immunosuppression, hypothyroidism, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, thromboembolic disorders, seizures, myasthenia gravis, ocular herpes simplex infection
• patients receiving concurrent systemic corticosteroids
• pregnant or breastfeeding patients
• children younger than age 6.
Administration
• If patient also uses a bronchodilator, give that drug at least 15 minutes before budesonide.
• Know that using a spacer reduces risk of candidiasis and hoarseness.
• Make sure patient swallows capsules whole without crushing or chewing them.
| Route | Onset | Peak | Duration |
| P.O. | Unknown | 0.5-10 hr | Unknown |
| Inhalation (nasal) | Immediate | 1-2 wk | Unknown |
Adverse reactions
CNS: headache, nervousness, depression, euphoria, psychoses, increased intracranial pressure
CV: hypertension, Churg-Strauss syndrome, thrombophlebitis, thromboembolism
EENT: cataracts, nasal congestion, nasal burning or dryness, epistaxis, perforated nasal septum, hoarseness, nasopharyngeal and oropharyngeal fungal infections
GI: nausea, vomiting, peptic ulcers, anorexia, esophageal candidiasis, dry mouth
Metabolic: hyperglycemia, decreased growth (in children), cushingoid appearance (moon face, buffalo hump), adrenal suppression or insufficiency
Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis
Respiratory: cough, wheezing, rebound congestion, bronchospasm
Skin: facial edema, rash, petechiae, contact dermatitis, acne, bruising, hirsutism, urticaria
Other: bad taste, anosmia, weight gain or loss, increased susceptibility to infection, angioedema, hypersensitivity reaction
Interactions
Drug-drug. Amphotericin B, mezlocillin, piperacillin, thiazide and loop diuretics, ticarcillin: additive hypokalemia
Digoxin: increased risk of digoxin toxicity
Erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, saquinavir: increased blood level and effects of budesonide
Fluoroquinolones: increased risk of tendon rupture
Hormonal contraceptives: blockage of budesonide metabolism
Insulin, oral hypoglycemics: increased budesonide requirement
Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse effects from budesonide
Nonsteroidal anti-inflammatory drugs (including aspirin): increased risk of adverse GI effects
Phenobarbital, phenytoin, rifampin: decreased budesonide efficacy
Somatrem, somatropin: decreased response to budesonide
Drug-food. Grapefruit, grapefruit juice: increased blood level and effects of budesonide
High-fat meal: delayed peak budesonide concentration
Patient monitoring
• Monitor respiratory status to evaluate drug efficacy.
☞ Stay alert for hypersensitivity reactions, especially angioedema.
• Evaluate liver function test results.
• Periodically observe patient for proper inhaler use.
• Assess oral cavity for infection.
Patient teaching
• Teach patient proper use of inhaler.
• Tell patient to swallow capsules whole without crushing or chewing them.
☞ Instruct patient to contact prescriber immediately if he develops itching, rash, fever, swelling of face and neck, or difficulty breathing.
• Encourage patient to document medication use and his response in diary.
• Advise patient to report signs and symptoms of fungal infections of mouth.
• Tell female patient to inform prescriber if she is pregnant or plans to become pregnant.
• Caution patient to avoid exposure to chickenpox and measles, if possible.
• Emphasize importance of rinsing mouth after each inhaler treatment and washing and drying inhaler thoroughly after each use.
• Instruct patient to avoid high-fat meals, grapefruit, and grapefruit juice.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and foods mentioned above.
budesonide
How to thank TFD for its existence? Tell a friend about us, add a link to this page, add the site to iGoogle, or visit webmaster's page for free fun content.
| ?Page tools | ||
|---|---|---|
|