Names and pronunciation
(byoo-des′oh-nide) Pulmicort Respules, Pulmicort Flexhaler Rhinocort Allergy Entocort EC, Tarpeyo, Uceris
Source page 197
Loading InternPractice…
Individual generic drug information
Extracted information for budesonide only.
(byoo-des′oh-nide) Pulmicort Respules, Pulmicort Flexhaler Rhinocort Allergy Entocort EC, Tarpeyo, Uceris
Source page 197
Func. class.: Glucocorticoid
Source page 197
Chem. class.: Nonhalogenated
Source page 197
ACTION: Prevents inflammation by depressing migration of polymorphonu- clear leukocytes and fibroblasts, reversal B of increased capillary permeability, and lysosomal stabilization; does not sup- press hypothalamus or pituitary function
Source page 197
USES: Rhinitis; prophylaxis for asthma; Crohn’s disease, ulcerative coli- tis, nasal polyps
Source page 197
Unlabeled uses: Microscopic colitis, laryngotracheobronchitis (croup)
Source page 197
Extracted information for budesonide only.
CONTRAINDICATIONS: Hyper- sensitivity, status asthmaticus, acute bronchospasm Precautions: Pregnancy, breastfeeding; children; TB; fungal, bacterial, systemic viral infections; ocular herpes simplex; nasal septal ulcers; hepatic disease, diabetes, GI disease, increased intraocular pressure
Source page 197
SIDE EFFECTS CNS: Headache, insomnia, hypertonia, syncope, dizziness, drowsiness CV: Chest pain, hypertension, sinus tachycardia, palpitation EENT: Sinusitis, pharyngitis, rhinitis, oral candidiasis ENDO: Adrenal insufficiency, growth sup- pression in children GI: Dry mouth, dyspepsia, nausea, vomit- ing, abdominal pain MISC: Ecchymosis, fever, hypersensitiv- ity, flulike symptoms, epistaxis, dysuria MS: Back pain, myalgias, fractures RESP: Nasal irritation, cough, nasal bleeding, respiratory infections, bronchospasm
Source page 198
INTERACTIONS Increase: budesonide effect—CYP3A inhibitors; dose adjustment may be needed • Avoid concurrent use of varicella live vaccine in pediatric patients
Source page 198
Extracted information for budesonide only.
DOSAGE AND ROUTES Rhinitis • Adult and child >12 yr: SPRAY/INH 2 sprays in each nostril AM, PM or 4 sprays in each nostril AM Asthma • Adult: INH 360 mcg bid, max 720 mcg bid • Child 1-8 yr previously taking broncho- dilator alone: NEB (Respules) 0.5 mg daily or 0.25 mg bid; suspension via jet nebulizer, max 0.5 mg daily; previously using inhaled corticosteroid 0.5 mg daily or 0.25 mg bid suspension via jet nebu- lizer, max 0.5 mg bid Crohn’s disease/ulcerative colitis (Uceris) • Adult: PO 9 mg/day AM × 8 wk Primary nephropathy (Tarpeyo) • Adult: PO 16 mg daily Laryngotracheobronchitis (croup) (unlabeled) • Infant ≥3 mo-child ≤5 yr: NEB (Pul- micort Respules INH suspension) 2 mg inhaled as a single dose
Source page 197
Available forms: Dry powder for INH 90, 100 , 180, 200, 400 ; 32 mcg/actua- tion (Rhinocort Aqua) nasal spray; suspen- sion for INH 0.5 mg/2 mL, 0.25 mg/2 mL; capsule 3 mg; extended-release tablet (Uceris) 9 mg, rectal foam 2 mg/actuation; delayed-release capsule 4 mg
Source pages 197, 198
Administer: PO route (Crohn’s disease/ulcerative colitis) • Swallow capsules whole; do not break, crush, chew; take in AM • May repeat 8-wk course if needed; may taper to 6 mg/day for 2 wk before cessation • Store at 59°F-86°F (15°C-30°C); keep away from heat, open flame Rectal foam route • Product is flammable, may use before bedtime, applicators are single use only Inhalation route • Prime inhaler before initial use only. Do not shake; do not use with spacer. After inhalation, rinse and spit with water Nasal route • Shake gently before use • Prime by actuating 8 times before ini- tial use • Reprime if not used for 2 consecutive days. If not used for 14 days, rinse the applicator and reprime until a fine mist appears
Source page 198
Extracted information for budesonide only.
Assess: • Respiratory status: rate, rhythm, in- crease in bronchial secretions, wheezing, chest tightness; provide fluids to 2 L/day to decrease thickness of secretions; check for oral candidiasis • Bronchospasm: stop treatment, give bronchodilator • Crohn’s disease/ulcerative colitis: as- sess for improvement in symptoms, decreased stools, abdominal cramps, urgency • HPA axis suppression: do not stop abruptly, taper • Viral infections: corticosteroid use can mask infections • Increased intraocular pressure: dis- continue use if this occurs • Beers: avoid in older adults; high risk of delirium • Pregnancy/breastfeeding: fetal harm ap- pears remote; excreted in breast milk; con- sider risk factors in continuing breastfeed- ing
Source page 198
Evaluate: • Therapeutic response: absence of asthma, rhinitis
Source page 198
CLINICAL CONSIDERATIONS
Source page 198
Patient and caregiver information: • To notify prescriber of pharyngitis, na- sal bleeding, oral candidiasis • Not to exceed recommended dose because adrenal suppression may occur • To carry emergency ID that identifies steroid use • To read and follow package directions • To prevent exposure to infections (es- pecially viral) • To use good oral hygiene if using nebulizer or inhaler • To avoid breastfeeding • That burning or stinging may occur with first few doses of inhalation use • That product is not a bronchodilator and not to be used for asthma; to use regu- larly • How to use as described in “Administer” • To notify prescriber if symptoms persist after weeks, that results usually take 2 wk • To notify prescriber if exposure to measles, chickenpox occurs
Source pages 198, 199
Extracted information for budesonide only.
PHARMACOKINETICS Peak: Respules 4-6 wk, Rhinocort Aqua 2 wk, half-life 2-3.6 hr Onset: Respules 2-8 days, Rhinocort Aqua 10 hr Enters breast milk
Source page 198
Filter the extracted dose blocks for this individual drug.
Rhinitis
• Adult and child >12 yr: SPRAY/INH 2 sprays in each nostril AM, PM or 4 sprays in each nostril AM Asthma
Candidate age grouping · source page 197
Rhinitis
• Adult: INH 360 mcg bid, max 720 mcg bid
Candidate age grouping · source page 197
Rhinitis
• Child 1-8 yr previously taking broncho- dilator alone: NEB (Respules) 0.5 mg daily or 0.25 mg bid; suspension via jet nebulizer, max 0.5 mg daily; previously using inhaled corticosteroid 0.5 mg daily or 0.25 mg bid suspension via jet nebu- lizer, max 0.5 mg bid Crohn’s disease/ulcerative colitis (Uceris)
Candidate age grouping · source page 197
Rhinitis
• Adult: PO 9 mg/day AM × 8 wk Primary nephropathy (Tarpeyo)
Candidate age grouping · source page 197
Rhinitis
• Adult: PO 16 mg daily Laryngotracheobronchitis (croup) (unlabeled)
Candidate age grouping · source page 197
Rhinitis
• Infant ≥3 mo-child ≤5 yr: NEB (Pul- micort Respules INH suspension) 2 mg inhaled as a single dose
Candidate age grouping · source page 197