budesonide

Drug Name

Generic Name : budesonide

Brand Name:

  • Inhalation: Entocort (CAN), Pulmicort Respules, Pulmicort Turbuhaler, Rhinocort Aqua, Rhinocort Turbuhaler (CAN)
  • Oral: Entocort EC

Classification:   Corticosteroid

Pregnancy Category B, C (oral) 

Dosage & Route
  • PO Inflammatory bowel disease Active: 9 mg/day, up to 8 wk. Maintenance: 6 mg once daily, up to 3 month. Inhalation Asthma As metered dose inhaler: 400 mcg/day in 2 divided doses, up to 1.6 mg/day in severe cases. Maintenance: 200-400 mcg/day. As dry powd inhaler: 200-800 mcg/day. As nebulised soln: Inhale 1-2 mg twice daily. Maintenance: 0.5-1 mg twice daily. Nasal Prophylaxis and treatment of rhinitis Initial: 200 mcg into each nostril daily, may reduce to 100 mcg into each nostril daily until symptoms are controlled. Nasal polyps 100 mcg twice daily into each nostril for up to 3 month.
Therapeutic actions
  • Budesonide controls the rate of protein synthesis, depresses the migration of polymorphonuclear leukocytes, fibroblasts, reverses capillary permeability and lysosomal stabilisation at the cellular level to prevent or control inflammation.
Indications
  • Management of symptoms of seasonal or perennial allergic rhinitis in adults and children; nonallergic perennial rhinitis in adults
  • Turbuhaler: Maintenance treatment of asthma as prophylactic therapy in adults and children > 6 yr and for patients requiring corticosteroids for asthma
  • Inhalation suspension: Maintenance treatment and prophylaxis therapy of asthma in children 12 mo–8 yr
  • Oral: Treatment and maintenance of clinical remission for up to 3 mo of mild to moderate active Crohn’s disease involving the ileum or ascending colon
Adverse effects
  • Loss of skin collagen and SC atrophy; local hypopigmentation of deeply pigmented skin; dryness, irritation, epistaxis, rarely ulceration or perforation of the nasal septum; smell and taste disturbances; hoarseness and candidiasis of the mouth or throat.
Contraindications
  • Hypersensitivity. Acute infections uncontrolled by antimicrobial chemotherapy.
Nursing considerations
Assessment
  • History: Untreated local nasal infections, nasal trauma, septal ulcers, recent nasal surgery, lactation
  • Physical: BP, P, auscultation; R, adventitious sounds; examination of nares
Interventions

Inhalation

  • BLACK BOX WARNING: Taper systemic steroids carefully during transfer to inhalational steroids; deaths from adrenal insufficiency have occurred.
  • Arrange for use of decongestant nose drops to facilitate penetration if edema, excessive secretions are present.
  • Prime unit before use for Pulmicort Turbuhaler; have patient rinse mouth after each use.
  • Use aerosol within 6 mo of opening. Shake well before each use.
  • Store Respules upright and protected from light; gently shake before use; open envelopes should be discarded after 2 wk.

Nasal inhalation

  • Prime pump eight times before first use. If not used for 2 consecutive days, reprime with 1 spray or until fine mist appears. If not used for more than 14 days, rinse applicator and reprime with 2 sprays or until fine mist appears.

Oral

  • Make sure patient does not cut, crush, or chew capsules; they must be swallowed whole.
  • Administer the drug once each day, in the morning; do not administer with grapefruit juice.
  • Encourage patient to complete full 8 wk of drug therapy.
  • WARNING: Monitor patient for signs of hypercorticism—acne, bruising, moon face, swollen ankles, hirsutism, skin striae, buffalo hump—which could indicate need to decrease dosage.
Teaching points

Inhalation

  • Do not use more often than prescribed; do not stop without consulting your health care provider.
  • It may take several days to achieve good effects; do not stop if effects are not immediate.
  • Use decongestant nose drops first if nasal passages are blocked.
  • Prime unit before use for Pulmicort Turbuhaler; rinse mouth after each use.
  • Store Respules upright, protect from light; discard open envelopes after 2 weeks; gently shake before use.
  • You may experience these side effects: Local irritation (use your device correctly), dry mouth (suck sugarless lozenges).
  • Report sore mouth, sore throat, worsening of symptoms, severe sneezing, exposure to chickenpox or measles, eye infections.

Oral

  • Take the drug once a day in the morning. Do not cut, crush, or chew the capsules, they must be swallowed whole.
  • If 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.
  • Take the full course of the drug therapy (8 weeks in most cases).
  • Do not take this drug with grapefruit juice; avoid grapefruit juice entirely while using this drug.
  • Store Respules upright, protected from light; discard open envelopes after 2 weeks. Shake before use.
  • You may experience these side effects: Dizziness, headache (avoid driving or operating dangerous machinery if these effects occur); nausea, flatulence (small, frequent meals may help; try to maintain your fluid and food intake).
  • Report chest pain, ankle swelling, respiratory infections, increased bruising.