Budesonide
Mechanism :
Budesonide is an anti-inflammatory corticosteroid that exhibits potent glucocorticoid activity and weak mineralocorticoid activity.
Indication :
- Bronchial asthma
- Bronchopulmonary dysplasia
- Croup
- Allergic rhinitis
Contraindications :
Contraindicated as the primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required. Hypersensitivity to budesonide or any of the ingredients of this preparation, compromised liver function and acute pulmonary tuberculosis are contraindications.
Dosing :
Asthma:
Nebuliser:
0.5 mg inhaled OD or divided into two doses daily. Maximum dose: 1 mg/day. Rinse mouth after use.
Inhalational powder/MDI:
Available as 100/200 mcg MDI/Rotacap
<6 years of age: Safety and efficacy not established.
>6 years of age: 100-200 mcg inhaled twice daily. In some patients may start at 400 mcg twice a day, do not exceed 400 mcg twice daily.
Allergic rhinitis:
Intranasal (Available as either 100 mcg or 32 mcg)
One spray for nostril every day (64 mcg/day).
6-11 years: Max: 2 sprays per nostril.
>12 years: Max: 4 sprays per nostril.
Mild to moderate Crohn's disease involving the ileum and/or ascending colon (Active disease):
Children >8 years and weight >25 kg: 9 mg PO OD in the morning for up to 8 weeks, followed by 6 mg PO OD for 2 weeks. If the patient was previously taking
prednisolone, do not abruptly discontinue
prednisolone; taper it down with the initiation of budes
Adverse Effect :
Mild irritation in the throat and hoarseness, respiratory infection, oral candidiasis, With intranasal administration: epistaxis, pharyngitis, nasal irritation.
Interaction :
Inhaled doses result in very low plasma levels; hence no drug interactions have been noted.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Unlikely to be dialysed. Dose as in normal renal function |
| HDF/High flux | Unlikely to be dialysed. Dose as in normal renal function |
| CAV/VVHD | Unlikely to be dialysed. Dose as in normal renal function |
Hepatic Dose :
Inhaled budesonide: No dosage adjustments are recommended.
Oral budesonide: Use a reduced dose of 3 mg OD in moderate hepatic impairment. Use is contraindicated in severe hepatic impairment.