budesonide (nasal)

Therapeutic Classification: corticosteroids

Pharmacologic Classification: corticosteroids

Indications ⬆ ⬇

REMS

Seasonal or perennial allergic rhinitis.

Action ⬆ ⬇

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects:

Decrease in symptoms of allergic rhinitis.

Pharmacokinetics ⬆ ⬇

Absorption: 34%; action is primarily local following nasal use.

Distribution: Crosses the placenta and enters breast milk in small amounts.

Protein Binding: 80–90%.

Metabolism/Excretion: Rapidly and extensively metabolized by the liver; 67% excreted in urine; 33% in feces.

Half-Life: 2–3 hr.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
Intranasal	1–2 days	2 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Active untreated infections;
Diabetes or glaucoma;
Underlying immunosuppression (due to disease or concurrent therapy);
Systemic corticosteroid therapy (should not be abruptly discontinued when intranasal therapy is started);
Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids);
OB: Has been used safely but should be used only if clearly needed.;
Lactation: Effects on infant are not known;
Pedi: Higher than recommended doses can lead to suppression of hypothalamic-pituitary-adrenal (HPA) function and suppression of linear growth.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: epistaxis, nasal burning, nasal irritation, nasopharyngeal fungal infection, pharyngitis, sneezing

GI: dry mouth, dyspepsia

Endo: adrenal suppression (increased dose, long-term therapy only), ↓growth (children)

Resp: bronchospasm, cough

Interactions ⬆ ⬇

Drug-drug:

Ketoconazole↓ metabolism and ↑ levels.

Route/Dosage ⬆ ⬇

(Adults and Children ≥12 yr): 1 spray in each nostril once daily (not to exceed 4 sprays in each nostril once daily). For OTC use, administer 2 sprays in each nostril once daily; once symptoms improve, ↓ to 1 spray in each nostril once daily.
(Children 6–11 yr): 1 spray in each nostril once daily (not to exceed 2 sprays in each nostril once daily).

Availability ⬆ ⬇

(Generic available)

Nasal spray suspension: 32 mcg/metered spray in 8.6–g bottle (delivers 120 metered sprays), 5–mL bottle (delivers 60 metered sprays)OTC, and 8.43-mL bottle (delivers 120 metered sprays)OTC
Powder for nasal inhalation: 100 mcg/inhalation (inhaler delivers 200 metered inhalations)

Assessment ⬆ ⬇

Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.
- Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
- Monitor growth rate in children receiving chronic therapy; use lowest possible dose.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Implementation ⬆ ⬇

After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before corticosteroid nasal spray.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication as directed. If a dose is missed, take as soon as remembered unless almost time for next dose.
Instruct patient to gently blow nose to clear nostrils prior to administering dose.
Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Shake well before use. Warn patient that temporary nasal stinging may occur.
Instruct patient to notify health care professional if symptoms do not improve within 2 wk, if symptoms worsen, or if nasal irritation occurs.
Nasal spray: Before first-time use, prime unit by actuating 8 times. If not used for 2 consecutive days, reprime with 1 spray or until fine spray appears. If not used for more than 2 wk, rinse applicator and reprime with 2 sprays or until fine spray appears.
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Pronunciation ⬇

Classifications ⬆ ⬇