Top 300 Pharmacy Drug Cards

BUDESONIDE: Pulmicort Respules, Pulmicort Flexhaler, Various

Class: Inhaled Corticosteroid

Dosage Forms. Inhalation Suspension: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL; Metered Dose Inhaler (MDI): 90 mcg/actuation, 180 mcg/actuation

Common FDA Label Indication, Dosing, and Titration.

1. Asthma: Children 1-8 y with no previous inhaled corticosteroid therapy, 0.5 mg inhaled via nebulization in 1 or 2 divided doses; Children 1-8 y previously treated with corticosteroids, 0.5 mg inhaled via nebulization daily or bid, may titrate to 1 mg/d; Children >8 y and Adults, 180-360 mcg bid via MDI, max 720 mcg bid via MDI

Off-Label Uses. None

MOA. Budesonide is an anti-inflammatory with potent glucocorticoid and weak mineralocorticoid activity. It exhibits a broad range of active inhibition against multiple cell types and mediators involving allergic and nonallergic/irritant-mediated inflammation.

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Drug Characteristics: Budesonide

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Medication Safety Issues: Budesonide

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Drug Interactions: Budesonide

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Adverse Reactions: Budesonide

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Efficacy Monitoring Parameters. Monitor PFTs. Resolution of asthma symptoms (symptoms, number of exacerbations, nighttime awakenings, need for rescue albuterol).

Toxicity Monitoring Parameters. Growth velocity in pediatric patients during prolonged therapy.

Key Patient Counseling Points. Advise patient on proper inhalation technique. Use entire vial of inhalation solution immediately after opening to avoid contamination; deliver over 5-15 min using a nebulizer with mouthpiece or face mask. After administration, rinse mouth with water and spit, and wash face to minimize risk of developing oral candidiasis. Provided as a strip of five small plastic containers with sealed caps; each container holds one dose. The strip of containers is sealed inside a foil pouch. Keep any unused containers inside the pouch. Once foil pouch is opened, the containers will only be good for 2 wk.

Clinical Pearls. This drug is not indicated for acute asthma attacks. Respules indicated only in children; budesonide in MDI form available for treatment of older children and adults. Also available in rectal and nasal formulations, and in MDI in combination with formoterol. Tablets and capsules available for the treatment of Crohn disease.