Adult Dosing
Maintenance of asthma
Pulmicort flexhaler
- Start: 180-360 mcg INH bid
- Max: 1440 mcg/day
Pulmicort turbuhaler
- Prior therapy with bronchodilators alone
- 200-400 mcg bid
- Max: 800 mcg/day
- Prior therapy with inhaled corticosteroids
- 200-400 mcg bid
- Max: 1600 mcg/day
- Prior therapy with oral corticosteroids
- 400-800 mcg bid
- Max: 1600 mcg/day
Notes:- Titrate to lowest effective dose
- Avoid mixing with other medications
- Gradually taper oral corticosteroids after therapy of 1wk
Pediatric Dosing
Maintenance of asthma
Budesonide, Pulmicort respules
- 1-8 yrs, with previous therapy of bronchodilators alone
- Start: 0.25-0.5 mg/day with nebulizer div Daily-bid
- Max: 0.5 mg/day
- 1-8 yrs, with previous therapy of inhaled corticosteroids
- Start: 0.5 mg/day with nebulizer div Daily-bid
- Usual dose: 0.25-1 mg/day
- Max: 1 mg/day
- 1-8 yrs, with previous therapy of oral corticosteroids
- Start: 1 mg/day with nebulizer div Daily-bid
- Usual dose: 0.25-1 mg/day
- Max: 1 mg/day
Pulmicort flexhaler
- 6-17 yrs
- Start: 180-360 mcg INH bid
- Max: 720 mcg/day
Pulmicort turbuhaler
- 6-17 yrs
- Prior therapy with bronchodilators alone
- 200 mcg bid
- Max: 800 mcg/day
- Prior therapy with inhaled corticosteroids
- 200 mcg bid
- Max: 800 mcg/day
- Prior therapy with oral corticosteroids
Notes:- Titrate to lowest effective dose
- Avoid mixing with other medications
- Gradually taper oral corticosteroids after therapy of 1wk
Croup [Non-FDA Approved]
- 2-4 mg nebulized (2 mg is most common). Some providers will nebulize 1 mg, then repeat in 30 minutes. Single dose appears effective
[Outline]
See Supplemental Patient Information
- Bone mineral density (BMD) have decreased on prolong use of inhaled corticosteroids
- On occurrence of bronchospasm immediately treat with a fast-acting inhaled bronchodilator, discontinue this drug and provide alternative treatment
- Candida albicans infection of the mouth and pharynx have occurred, periodically monitor patients for signs of adverse effects
- Corticosteroids cause development of glaucoma and/or cataracts. Monitor patients with history of increased IOP, glaucoma, and/or cataracts for changes in vision
- Remain alert to eosinophilic conditions and Churg-Strauss syndrome
- Reduction in growth velocity may occur in pediatric patients; monitor periodically
- Increased risk of immunosuppression and infections; avoid exposure of patients who have not suffered from chickenpox/measles or have been properly immunized. Start prophylaxis with varicella zoster immune globulin (VZIG) if exposed to chickenpox and with pooled immunoglobulin (IG) if exposed to measles
- Worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infection, or ocular herpes simplex, serious or life threatening course of chickenpox or measles in susceptible patients may occur
- Impaired adrenal function have occurred when transferring from oral steroids to inhaled corticosteroids, gradually taper dose while transferring from systemic corticosteroids to inhaled corticosteroids
- Adrenal insufficiency and hypercorticism may occur at higher than recommended dosages or even at recommended dosages in susceptible individuals. Withdraw gradually to discontinue
Cautions: Use cautiously in
- Active or quiescent tuberculosis infections
- Untreated local or systemic fungal or bacterial infections
- Systemic viral or parasitic infections
- Ocular herpes simplex infections
- Measles or varicella exposure
- Glaucoma
- Cataracts
- Increased intra ocular pressure
- Adrenal insufficiency
- Adrenal suppression, hypercorticism
- Use of systemic steroid
- History or risk of decreased bone mineral density
- Vision changes
- Adolescent patients
- Pediatric patients
- Geriatrics
Supplemental Patient Information
- Advise patients to rinse mouth following inhalation
- Advise patients to contact their physician immediately if episodes of asthma are not responsive to their usual doses of bronchodilators during the course of therapy
Pregnancy Category:B
Breastfeeding: Less amounts of inhaled budesonide are excreted into breastmilk and negligible amount is exposed to infant. Inhaled corticosteroids are considered acceptable to use during breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 24 February 2011). According to manufacturer's data a decision is essential for discontinuing nursing or discontinuing the drug taking into account the importance of the drug to the mother.
US Trade Name(s)
- Pulmicort turbuhaler
- Pulmicort flexhaler
- Pulmicort respules
US Availability
budesonide (generic)
- SUSP for INH: 0.25 mg/2 mL
- SUSP for INH: 0.5 mg/2 mL
Pulmicort turbuhaler
- PWDR for INH: 0.16 mg/INH
Pulmicort flexhaler
- PWDR for INH: 0.08 mg/INH
- PWDR for INH: 0.16 mg/INH
Pulmicort respules
- SUSP for INH: 0.25 mg/2 mL
- SUSP for INH: 0.5 mg/2 mL
- SUSP for INH: 1 mg/2 mL
Canadian Trade Name(s)
- Pulmicort nebuamp
- Pulmicort turbuhaler
- Rhinocort turbuhaler
Canadian Availability
Pulmicort nebuamp
- SUSP for INH: 0.125 mg/mL
- SUSP for INH: 0.25 mg/mL
- SUSP for INH: 0.5 mg/mL
Pulmicort turbuhaler
- MDI: 100 mcg/INH
- MDI: 200 mcg/INH
- MDI: 400 mcg/INH
Rhinocort turbuhaler
- PWDR for INH: 100 mcg/INH
UK Trade Name(s)
- Budelin
- Novolizer
- Pulmicort CFC-free inhaler
- Pulmicort respules
- Pulmicort turbuhaler
UK Availability
budesonide (generic)
- PWDR for INH: 100 mcg/INH
- PWDR for INH: 200 mcg/INH
- PWDR for INH: 400 mcg/INH
Budelin, Novolizer
- PWDR for INH: 200 mcg/INH
Pulmicort CFC-free inhaler
- SUSP for INH: 0.125 mg/mL
- SUSP for INH: 100 mcg/INH
- SUSP for INH: 200 mcg/INH
Pulmicort respules
- SUSP for INH: 0.25 mg/mL
- SUSP for INH: 0.5 mg/mL
Pulmicort turbuhaler
- PWDR for INH: 100 mcg/INH
- PWDR for INH: 200 mcg/INH
- PWDR for INH: 400 mcg/INH
Australian Trade Name(s)
Australian Availability
Pulmicort turbuhaler
- MDI: 100 mcg/INH
- MDI: 200 mcg/INH
- MDI: 400 mcg/INH
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Pulmicort Flexhaler 90 MCG/ACT AEPB [Inhaler] (ASTRAZENECA LP)
1 act = $121.99
3 act = $335.99 - Pulmicort Flexhaler 180 MCG/ACT AEPB [Inhaler] (ASTRAZENECA LP)
1 act = $159.98
3 act = $455.95 - Budesonide 0.5 MG/2ML SUSP [Box] (TEVA PHARMACEUTICALS USA)
60 2ml = $259.99
180 2ml = $759.98 - Budesonide 0.25 MG/2ML SUSP [Box] (TEVA PHARMACEUTICALS USA)
60 2ml = $205.99
180 2ml = $615.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
6 yrs of age (Pulmicort flexhaler, Pulmicort turbuhaler)