Budesonide

Overview

Budesonide is a drug that is used via an inhaler or nebulizer in order to help manage and prevent the symptoms of asthma. When used by asthma sufferers on a daily basis, inhaled budesonide can reduce the number and severity of asthma attacks that occur. It should be noted, however, that this medication will not work to relieve an asthma attack that is already in effect. Your doctor will prescribe you an alternative medication for use during an asthma attack.

In the US, Budesonide is sold under the brand names Pulmicort Flexhaler, Pulmicort Respules, and Pulmicort Turbuhaler. In Canada, the drug is marketed under the brand names Pulmicort, Pulmicort Nebuamp, and Rhinocort Turbuhaler.

Budesonide is a corticosteroid medication. The drug works by preventing inflammation of the structures inside the patient’s lungs, effectively reducing the severity of an asthma attack. Inhaled budesonide can safely be used in conjunction with other asthma medications and bronchodilators, which are designed to open up the narrowed breathing passages in the lungs. The overall effect allows air to flow more freely in and out of the lungs, preventing the distressing and potentially dangerous effects of a serious asthma attack.

Budesonide is only available on prescription from your doctor. The drug comes in a number of different forms including suspension, powder, solution, aerosol powder, and aerosol liquid. You will be provided with an inhaler or nebulizer machine with your prescription, and your doctor will show you how to use them.

Conditions treated

  • asthma

Type of medicine

  • corticosteroid
  • inhaler
  • suspension
  • powder
  • solution
  • aerosol powder
  • aerosol liquid

Side-effects

Together with the many benefits that budesonide can bring to asthma sufferers, a few patients sometimes have some unwanted or unpleasant side-effects when they begin using the drug. Most of these side-effects will not affect you. However, if you do begin to notice any unusual or unpleasant effects, consult your doctor promptly, as you may need further medical attention.

The following side-effects are quite common in people taking budesonide and should be reported to your doctor immediately.

  • vomiting
  • voice changes
  • tightness of the chest or wheezing
  • tender, swollen neck glands
  • sweating
  • stuffy or runny nose
  • sneezing
  • shortness of breath or breathing difficulties
  • problems when swallowing
  • pain or tenderness around the eyes and cheekbones
  • nausea
  • muscle aches and pains
  • loss of appetite
  • joint pain
  • insomnia
  • headache
  • general aches, pains, or feeling ill
  • fever
  • feeling unusually tired or weak
  • dryness, hoarseness, or soreness of the throat
  • diarrhea
  • cough
  • congestion
  • chills and shivering

The following side-effects occur less often in people taking budesonide and should be reported to your doctor straight away.

  • white patches on the tongue or inside the mouth
  • sore mouth or tongue
  • skin rashes
  • redness or swelling inside the ear
  • pain or difficulty urinating
  • muscle stiffness, tension, or tightness
  • lower back or side pain
  • fractures
  • flat blue, or purple patches on the skin
  • fainting
  • earache
  • dizziness
  • development of excessive muscle tone
  • depression
  • darkening of the skin
  • bruising

There are a number of side-effects that can appear in people who are taking this medication that do not usually require further medical attention. These effects often resolve themselves within a week or so, as the body becomes acclimatized to the new drug. Ask your doctor for advice on how to prevent or reduce the following unpleasant side-effects if they prove to be persistent or particularly bothersome:

  • swollen joints
  • stomach discomfort, upset, or pain
  • severe and throbbing headache
  • runny nose or sneezing
  • neck pain
  • muscle cramps
  • insomnia
  • indigestion
  • heartburn
  • feeling of weakness
  • ear congestion
  • dry mouth
  • difficulty moving
  • difficulty breathing
  • change in taste or unpleasant after-taste
  • belching
  • back pain
  • acid or sour stomach

It should be noted that this list of side-effects is not all-inclusive. If you begin to experience any other unusual effects that are not mentioned above, you should report them to your doctor without delay.

Dosage

Your budesonide inhaler is not intended to stop an asthma attack that has already begun. To relieve an asthma attack that is already affecting you, you should use another appropriate medication. If you do not have another suitable drug, speak to your doctor without delay.

You will be given a medication guide when your doctor prescribes budesonide for you. Be sure to read the guide thoroughly so that you understand how to use your medication. If you have any questions, ask your doctor or pharmacist.

You must only take this medication exactly as your doctor directs. Do not take more than the prescribed dose. Do not use the drug more often than you have been told to, and do not use the medication for longer than directed by your doctor. Do not miss any doses. Do not stop taking the medication unless your doctor instructs you to do so. Stopping the medication could increase the likelihood of you suffering unpleasant side-effects and could make your condition worse.

For budesonide to work properly and prevent asthma attacks, you must use it every day in evenly spaced doses, as directed by your doctor. You should begin to see an improvement in your condition within 24 to 48 hours, but it could take between two and six weeks before you feel the full benefit.

Guidelines for using the Pulmicort FlexhalerTM

The Pulmicort FlexhalerTM is dispensed as a powder that is inhaled into the lungs via an inhaler that is placed into the mouth. This form of inhaler can be used by adults, teenagers, and children under the age of six.

Do not use the inhaler if it appears damaged or if the mouthpiece has become detached. Do not use a spacer with the inhaler.

  • The first time that you use your inhaler, you should test or prime it, as it may not deliver the correct dose. To do this, hold the inhaler with its white cover pointing upwards. Twist the cover and lift it off. Hold the inhaler with the mouthpiece facing up, using the brown grip. Twist the centre of the inhaler fully in one direction, and then back again in the opposite direction. You should now hear a ‘click’. Repeat the process a second time to fully prime your inhaler. You will not have to prime the device again once the above procedure has been completed.
  • Now that the inhaler is primed, twist the cover and remove it. Hold the inhaler upright, and then twist the grip in one direction as far as it will go. Twist the grip back again in the opposite direction, until you hear a click.
  • Breathe out deeply, with your head turned away from the inhaler.
  • Do not shake the inhaler.
  • Put the mouthpiece between your lips and breathe in forcefully and as deeply as you can. You may not feel or taste the drug as you inhale. Do not bite down or chew on the mouthpiece.
  • Remove the inhaler from your mouth and breathe out normally. Avoid blowing or breathing into the inhaler.
  • If a further dose is needed, repeat the steps as outlined above.
  • Once you have finished using the medication, put the cover back on to the inhaler and twist it firmly shut. Rinse out your mouth with clean water. Do not swallow the water; spit it out. This should prevent any irritation to your throat, and should also reduce the risk of mouth infections or hoarseness.
  • Your inhaler has a dose indicator that enables you to keep track of how many doses are remaining before you need to start a fresh one. Check the indicator just below the inhaler mouthpiece. The indicator should start with the number 60 or 120, when the inhaler is full. When a number ‘zero’ appears in the dose indicator window, the inhaler is empty and should be discarded. You will receive a new inhaler each time you need to refill your prescription.

Be sure to follow the directions in your Medication Guide for storing and cleaning the inhaler.

Guidelines for using the Pulmicort Respules® liquid

The Pulmicort Respules® liquid is dispensed as a liquid that you will breathe into your lungs through a breathing machine called a jet nebulizer. The nebulizer comes with a mouthpiece or face mask. Nebulizers are generally used by children between 12 months and eight years of age.

Your doctor will advise you on the type of nebulizer device you should use and will show you how to use it. Your prescription and the nebulizer will come with detailed patient instructions. Read these instructions carefully before you use the machine and the medication. If you are unclear on how to use the machine, ask your doctor for further guidance.

The medication should be used at the same time each day, unless you are instructed otherwise by your doctor. Do not mix the liquid with any other medications.

  • Start by opening up the aluminum foil packet. Remove one plastic container of liquid from the strip of five containers with sealed caps. Each container holds one dose of budesonide. When you open the foil envelope, remember to write that day’s date on the back.
  • Replace any unused containers in the foil pouch to keep them protected from light.
  • Shake the container in a gentle circular motion before you use it.
  • Hold the container upright and twist off the cap to open it. Carefully squeeze out the contents of the container into the nebulizer cup. Discard the empty container.
  • If you are using the face mask to administer the drug to your child, ensure that the mask fits securely over their face so that the drug does not get into their eyes.
  • Switch on the compressor to start the nebulizing process. The machine converts the liquid into a fine mist that the child inhales into their lungs via the mask or mouthpiece.
  • When the dose is complete, wash the child’s face to prevent irritation to the skin.
  • Rinse out your child’s mouth with clean water. Do not allow the child to swallow the water; encourage them to spit it out. This should prevent any irritation to the throat, and should also reduce the risk of mouth infections or hoarseness.

The dose of budesonide that you are prescribed will vary between patients. Follow your doctor’s instructions or the directions given on the medication’s dispensary label. The dosage levels outlined here are solely based on the average. If the dose you are told to take is different, do not change it unless instructed to do so by your doctor.

The dose of this medication that you are given might vary, depending on the strength of the preparation, as may the number of doses you are told to take each day, and the duration of your course of treatment.

For the prevention of an asthma attack – powder inhaler

  • Adults and children aged six years and older: one or two puffs twice a day. The dose may be adjusted by your doctor, as necessary.
  • Children under six years of age: use and dosage as instructed by your doctor.

For the prevention of an asthma attack – suspension in a nebulizer

  • Children aged 12 months to eight years of age: 0.5 to 1 mg in a nebulizer once daily or split into two doses and given twice daily. Use a new container for each dose.
  • Infants under 12 months of age: use and dosage as instructed by your doctor.

If you miss a dose of the medicine, try to take it as soon as possible. However, if it is almost time for your next dose, omit this one and revert to your usual schedule. Do not take double doses.

Do not share this medication with anyone else.

If you find that the frequency of your asthma attacks fails to reduce or gets worse while you are taking this medication, you must consult your doctor promptly.

In the event that you overdose, you may experience breathing problems or have fainting episodes. If you think you may have overdosed, seek your doctor’s advice immediately or call 911.

Major drug interactions

Some medicines must not be used together, as this may change how your drugs work and could also increase the likelihood of you experiencing more serious side-effects. However, in some cases, two or more different drugs may be used together, even though an interaction may occur. Your doctor may decide to adjust the dose of one of your medicines. Alternatively, there may be some precautions that you can take to negate the effect of any interactions, and your doctor will advise you further on this.

Before commencing treatment with budesonide, make a list of all medicines that you currently use, including prescription and non-prescription drugs, herbal remedies, and vitamin supplements, and give the list to your doctor. Do not change the dose or frequency of any of your prescribed or non-prescription medications without first checking with your doctor.

It is not generally recommended that budesonide is used with any of the following drugs, although your doctor may decide that this is appropriate in some cases. The dose or frequency of one or both of the medications may be adjusted by your doctor.

  • Valdecoxib
  • Tosufloxacin
  • Tolmetin
  • Tolfenamic Acid
  • Tiaprofenic Acid
  • Tenoxicam
  • Telaprevir
  • Sulindac
  • Sparfloxacin
  • Sodium Salicylate
  • Salsalate
  • Salicylic Acid
  • Rufloxacin
  • Rofecoxib
  • Ritonavir
  • Prulifloxacin
  • Proquazone
  • Propyphenazone
  • Proglumetacin
  • Pranoprofen
  • Pixantrone
  • Piroxicam
  • Piketoprofen
  • Phenylbutazone
  • Pefloxacin
  • Pazufloxacin
  • Parecoxib
  • Oxyphenbutazone
  • Oxaprozin
  • Ofloxacin
  • Norfloxacin
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Niflumic Acid
  • Nepafenac
  • Naproxen
  • Nadroparin
  • Nadifloxacin
  • Nabumetone
  • Moxifloxacin
  • Morniflumate
  • Meloxicam
  • Mefenamic Acid
  • Meclofenamate
  • Lumiracoxib
  • Lumacaftor
  • Loxoprofen
  • Lornoxicam
  • Lomefloxacin
  • Levofloxacin
  • Ketorolac
  • Ketoprofen
  • Ketoconazole
  • Indomethacin
  • Idelalisib
  • Ibuprofen
  • Gemifloxacin
  • Gatifloxacin
  • Flurbiprofen
  • Flumequine
  • Flufenamic Acid
  • Floctafenine
  • Fleroxacin
  • Feprazone
  • Fepradinol
  • Fenoprofen
  • Felbinac
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Erythromycin
  • Enoxacin
  • Droxicam
  • Dipyrone
  • Diflunisal
  • Diclofenac
  • Dexketoprofen
  • Dexibuprofen
  • Darunavir
  • Conivaptan
  • Cobicistat
  • Clonixin
  • Ciprofloxacin
  • Choline Salicylate
  • Ceritinib
  • Celecoxib
  • Bupropion
  • Bufexamac
  • Bromfenac
  • Boceprevir
  • Besifloxacin
  • Bemiparin
  • Balofloxacin
  • Amtolmetin Guacil
  • Acemetacin
  • Aceclofenac

Some drugs should not be used while using alcohol or tobacco, or while eating food or certain foodstuffs, as an interaction could occur. You should discuss this with your doctor before you begin using budesonide.

Warnings

While you are taking this drug, you must see your doctor for regular check-ups. These appointments are very important as they give the doctor the chance to check that the medication is working properly. You will also have the chance to mention any side-effects that you may have noticed and to air any concerns that you may have about your new medication. Your doctor might also want to carry out blood tests to check for any unwanted effects that the medication is causing.

Do not use this medication if an asthma attack has already begun. Your treating physician will prescribe you a short-acting inhaler for use during an acute asthma attack. If you do not notice an improvement in your or your child’s symptoms, or if they actually get worse, consult your doctor without delay.

Budesonide can weaken the immune system in some patients. Try to avoid being in an environment where you could contract an infection. Try to keep away from people who have recently had measles or chicken pox, and tell your doctor immediately if you think you have been exposed to either of these conditions.

If you or your child develop any form of allergic reaction, a skin rash, or hives, stop using the medication and immediately consult your doctor.

Budesonide can increase the risk of mouth and throat infections. Contact your doctor if you develop sores in your mouth or throat.

In patients who take budesonide over a long period of time, low bone mineral density may develop, which could cause fragile bones or osteoporosis. Speak with your doctor for more information about this if you have any concerns or questions.

This drug can cause some children to have a slower growth rate than normal, potentially causing a child not to become taller or gain weight. If you think your child is being affected in this way, mention your concerns to your doctor.

Budesonide can increase the risk of your adrenal gland becoming less active than it should be. This effect is more likely in people who are taking steroids over a long time or in very high doses. Ask your doctor for advice if you or your child experience more than one of the following symptoms:

  • weight gain around the face, neck, and trunk
  • vomiting
  • unusual tiredness or weakness
  • skin rash
  • pimples
  • nausea
  • menstrual cycle changes
  • loss of appetite
  • fainting
  • dizziness
  • diarrhea
  • depression
  • darkening of the skin
  • acne

If you experience visual disturbances, including blurred vision or difficulty in reading, your doctor may refer you to an ophthalmologist for further investigations.

It may be necessary to stop using this medication a few days prior to having surgery or dental treatment. Ask your doctor’s advice if this applies to you or your child.

Your doctor may suggest that you or your child carry a medical identification card, stating that you are using this drug.

Be sure to tell your doctor if you are already on any other medicines. This should also include over-the-counter products, herbal remedies, and vitamin supplements. In addition, you should tell your doctor if you know that you are allergic to food colourings, particular foods, preservatives, or animal derivatives.

Some medical conditions can affect how this medication works. Tell your doctor if you suffer from any other health problems.

Budesonide should NOT be used in patients with a history of acute asthma attacks.

This drug should be used with caution in patients with the following conditions, as it could make them worse:

  • bone conditions, including osteoporosis
  • cataracts
  • glaucoma

Budesonide should not be used in patients who suffer from the following conditions, as it can reduce the body’s ability to fight off these infections:

  • chicken pox
  • measles
  • herpes simplex virus infection of the eye
  • viral, fungal, or bacterial infections
  • tuberculosis

Pulmicort FlexhalerTM should be used with caution in people who have a known allergy to milk protein. This product contains lactose and it could cause side-effects in patients with this condition.

Budesonide is not known to have an adverse effect on unborn babies and is not thought to be passed through breast milk. However, if you are pregnant or breastfeeding, you might want to discuss the use of this drug with your doctor if you are concerned.

Storage

Always keep budesonide safely out of the reach of children and pets. If a pet does consume this medication, you should seek immediate veterinary advice.

Do not keep any unwanted budesonide liquid or inhalers. Do not use any drugs that have exceeded their use-by date. Do not dispose of any unwanted medical supplies by flushing the product down the toilet or drain. Do not throw out unused medication with your trash where it could be found and consumed by a child.

Seek the advice of your doctor or pharmacist if you need to dispose of any unused or unwanted medicines.

The Pulmicort FlexhalerTM should be stored at room temperature in a dry place with its cover firmly affixed.

Pulmicort Respules® should be stored in an upright position and at room temperature. Do not keep them in the fridge or freezer. The medicine containers should be kept in the foil pouch until you need to use them. Once a pouch has been opened, the containers will only last for two weeks. Any unused containers should be thrown away if more than two weeks has elapsed since the pouch was opened.

Summary

In the US, Budesonide is sold under the brand names, Pulmicort Flexhaler, Pulmicort Respules, and Pulmicort Turbuhaler.

Budesonide is a drug that is used to help manage and prevent the symptoms of asthma. Inhaled budesonide can reduce the number and severity of asthma attacks suffered by the patient, although the medication cannot be used to relieve an asthma attack that has already started.

Budesonide is a corticosteroid medication and is dispensed via an inhaler or a nebulizer in children. The drug prevents inflammation inside the sufferer’s lungs, reducing the severity of asthma attacks and helping to reduce their frequency.

This medication is only available on prescription from your doctor. The drug comes in a number of different forms including, suspension, powder, solution, aerosol powder, and aerosol liquid.

The drug can have a number of unpleasant side-effects, including a cough, or breathing problems. Shortness of breath, dizziness, and fainting can also occur in some patients.

There are a number of commonly prescribed and non-prescription drugs that can interact adversely with this medication. Long-term use of budesonide can lower the body’s immune response to infection, leaving some patients more susceptible to common infectious diseases, including chicken pox, measles, and other fungal, viral, and bacterial infections.

Budesonide is highly effective in reducing the severity of severe asthma attacks and in preventing them. If you are to benefit fully from a course of treatment with this drug, you should work closely with your doctor in order to work out the correct dose and dosage schedule for the medication for you or your child. This process will require that you see your doctor regularly for progress checks and blood tests. These tests and discussions are necessary in order to make sure that the medication is working properly, and that it is not causing any unwanted or potentially harmful side-effects.