Budesonide

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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 w/ 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 w/ 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 w/ 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 w/ 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 w/ 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

Adverse Reactions

Serious

Common

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.

Comments

See Also

References