Budesonide: Difference between revisions

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==Pediatric Dosing==
==Pediatric Dosing==
*[[Asthma]] maintenance
*[[Asthma]] maintenance
**1-8 yo w/ prior bronchodilator alone
**1-8 yo with prior bronchodilator alone
***0.25-0.5 mg/day NEB divided qd-BID
***0.25-0.5 mg/day NEB divided QD-BID
****Start: 0.5 mg/day
****Start: 0.5 mg/day
****Max: 0.5 mg/day. Titrate to lowest effective dose.
****Max: 0.5 mg/day. Titrate to lowest effective dose.
**1-8 yo w/ prior inhaled steroid
**1-8 yo with prior inhaled steroid
***0.25-1 mg/day NEB divided qd-BID
***0.25-1 mg/day NEB divided QD-BID
****Start: 0.5mg/day
****Start: 0.5mg/day
****Max: 1 mg/day. Titrate to lowest effective dose.
****Max: 1 mg/day. Titrate to lowest effective dose.
**1-8 yo w/ prior oral steroid
**1-8 yo with prior oral steroid
***0.25-1 mg/day NEB divided qd-BID
***0.25-1 mg/day NEB divided QD-BID
****Start: 1 mg/day
****Start: 1 mg/day
****Max: 1 mg/day. Titrate to lowest effective dose. Taper oral steroid gradually after >1 week.
****Max: 1 mg/day. Titrate to lowest effective dose. Taper oral steroid gradually after >1 week.
*[[Eosinophilic esophagitis]]
*[[Eosinophilic esophagitis]]
**<11 yo: 1 mg PO qd x4-12 weeks
**<11 yo: 1 mg PO QD x4-12 weeks
***Mix 1 mg/2mL NEB w/ 5 g sucralose to form PO slurry.  
***Mix 1 mg/2mL NEB with 5 g sucralose to form PO slurry.  
***Avoid food/drink x30 min after each dose
***Avoid food/drink x30 min after each dose
**11+ yo: 2 mg PO qd x4-12 weeks
**11+ yo: 2 mg PO QD x4-12 weeks
***Mix 2 mg/4mL NEB w/ 10 g sucralose to form PO slurry.
***Mix 2 mg/4mL NEB with 10 g sucralose to form PO slurry.
***Avoid food/drink x30 min after each dose
***Avoid food/drink x30 min after each dose


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B; drug of choice for pregnant pts w/ persistent asthma
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B; drug of choice for pregnant patients with persistent asthma
*[[Lactation risk categories|Lactation risk]]: L3; Safety unknown
*[[Lactation risk categories|Lactation risk]]: L3; Safety unknown
 
*Renal dosing: not defined
===Renal Dosing===
*Hepatic dosing: not defined, monitor closely
*Adult: Not defined
*Pediatric: Not defined
 
===Hepatic Dosing===
*Adult: Not defined. Monitor closely with impairment.
*Pediatric: Not defined. Monitor closely with impairment.


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*[[Asthma]], acute
*[[Asthma]], acute
*[[Status asthmaticus]]
*[[Acute asthma exacerbation]]
 
*Bronchospasm, acute
*Avoid abrupt withdrawal


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*[[Anaphylaxis]]
*Bronchospasm
*Hypersensitivty reaction, incl. rash
*[[Angioedema]]
*Adrenal suppression
*[[Cushing syndrome]]
*Hypercorticism
*Growth suppression
*[[Eosinophilia]]
*[[Churg-Strauss syndrome]]
*[[Glaucoma]]
*Cataracts
*Osteoporosis


===Common===
===Common===
*[Upper respiratory infection]]
*Rhinitis
*[[Cough]]
*[[Otitis media]]
*Viral infection
*[[Candidiasis]], oral
*[[Gastroenteritis]]
*[[Vomiting]]
*[[Diarrhea]]
*[[Abdominal pain]]
*[[Epistaxis]]
*[[Conjunctivitis]]
*[[Rash]]


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 2.3 hr
*Metabolism:  
*Metabolism: Liver; CYP450: 3A4 substrate
*Excretion:  
*Excretion: Urine 60%, feces


==Mechanism of Action==
==Mechanism of Action==
Inhibits multiple inflammatory cytokines and produces multiple glucocorticoid and mineralcorticoid effects. Exact mechanism unknown.


==Comments==
==Comments==
Line 67: Line 89:
==References==
==References==
<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]] [[Category:Pulmonology]]

Latest revision as of 21:37, 19 September 2019

Administration

  • Type: Inhaled corticosteroid
  • Dosage Forms: 3 DR
  • Routes of Administration: Inhaled
  • Common Trade Names: Pulmicort

Adult Dosing

  • 1.5-2 mg NEB q 6 hr
    • Do not mix with other nebulized medications and rinse mouth after use

Pediatric Dosing

  • Asthma maintenance
    • 1-8 yo with prior bronchodilator alone
      • 0.25-0.5 mg/day NEB divided QD-BID
        • Start: 0.5 mg/day
        • Max: 0.5 mg/day. Titrate to lowest effective dose.
    • 1-8 yo with prior inhaled steroid
      • 0.25-1 mg/day NEB divided QD-BID
        • Start: 0.5mg/day
        • Max: 1 mg/day. Titrate to lowest effective dose.
    • 1-8 yo with prior oral steroid
      • 0.25-1 mg/day NEB divided QD-BID
        • Start: 1 mg/day
        • Max: 1 mg/day. Titrate to lowest effective dose. Taper oral steroid gradually after >1 week.
  • Eosinophilic esophagitis
    • <11 yo: 1 mg PO QD x4-12 weeks
      • Mix 1 mg/2mL NEB with 5 g sucralose to form PO slurry.
      • Avoid food/drink x30 min after each dose
    • 11+ yo: 2 mg PO QD x4-12 weeks
      • Mix 2 mg/4mL NEB with 10 g sucralose to form PO slurry.
      • Avoid food/drink x30 min after each dose

Special Populations

  • Pregnancy Rating: B; drug of choice for pregnant patients with persistent asthma
  • Lactation risk: L3; Safety unknown
  • Renal dosing: not defined
  • Hepatic dosing: not defined, monitor closely

Contraindications

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 2.3 hr
  • Metabolism: Liver; CYP450: 3A4 substrate
  • Excretion: Urine 60%, feces

Mechanism of Action

Inhibits multiple inflammatory cytokines and produces multiple glucocorticoid and mineralcorticoid effects. Exact mechanism unknown.

Comments

See Also

References

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