BMA Concise Guide to Medicine & Drugs

Budesonide

Brand names Budelin, Budenofalk, Entocort, Novolizer, Pulmicort, Rhinocort Aqua

Used in the following combined preparation Symbicort

QUICK REFERENCE

Drug group Corticosteroid

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Budesonide is a corticosteroid drug used as slow-release capsules to relieve the symptoms of Crohn’s disease, as an enema to treat ulcerative colitis, and as an inhaler to prevent (but not stop existing) asthma attacks. Like other corticosteroids, it is used when asthma is not controlled by bronchodilators alone. It is also used as a nasal spray to relieve the symptoms of allergic rhinitis and for nasal polyps. Side effects are fewer and less serious with the inhaler or nasal spray because less of the drug is absorbed than with oral forms. However, mouth and throat irritation can occur with the inhaler, but can be minimized by thoroughly rinsing the mouth and gargling with water after each inhalation.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used SR capsules, enema, inhaler, powder for inhalation, nasal spray.

Frequency and timing of doses 1–3 x daily (capsules); once daily at bedtime (enema); twice daily (inhaler); once or twice daily (nasal spray).

Dosage range 3–9mg (capsules); 2mg (enema); 200–1,600mcg (inhaler); 100–200mcg (nasal spray).

Onset of effect Asthma Within 1 week. Other conditions 1–3 days

Duration of action 12–24 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor; symptoms may recur. The SR-capsules used in Crohn’s disease should be withdrawn gradually.

Exceeding the dose An occasional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

The main side effects of inhalers and nasal sprays are largely confined to the upper airway and mouth. They include cough, nasal irritation, bruising, sore throat, hoarseness, and, rarely, nosebleeds. Capsules and enemas may cause gastrointestinal disturbances, such as diarrhoea or constipation, and sometimes a rash and/or itching. High doses of budesonide by any route can cause weight gain and, if used for prolonged periods, other long-term side effects associated with corticosteroids (see Prolonged use). Contact your doctor if nosebleeds, sore throat, hoarseness, rash, itching, or weight gain occur, or if any of the other side effects are severe.

INTERACTIONS

Itraconazole, ritonavir, and telaprevir may increase the blood level of budesonide and the risk of adrenal gland suppression.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have had tuberculosis or another respiratory infection.

· You are taking other medicines.

Pregnancy Discuss with your doctor, especially if used for Crohn’s disease.

Breast-feeding Discuss with your doctor, especially if used for Crohn’s disease.

Infants and children Reduced dose necessary.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol No special problems.

Infection Avoid exposure to chickenpox.

PROLONGED USE

Asthma prevention is the condition for which prolonged use may be required. High doses inhaled for a prolonged period can lead to peptic ulcers, osteoporosis, glaucoma, muscle weakness, and growth retardation in children. Patients taking the drug long term are advised to carry a steroid card or wear a MedicAlert bracelet.

Monitoring If budesonide is being taken in large doses, periodic checks may be needed to make sure that the adrenal glands are working properly. Children using inhalers should have their growth (height) monitored regularly.