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Pulmicort Flexhaler
budesonide inhaled
Adult Dosing .
Dosage forms: DPI: 90 mcg per actuation, 180 mcg per actuation
asthma, maintenance tx
- [1-2 puffs inhaled bid]
- Start: varies by disease severity and current asthma tx, may incr. dose after 1-2wk; Max: 1440 mcg/day; Info: taper to lowest effective dose; search 'asthma' for epocrates Asthma Long-Term Management NIH/NHLBI decision tools
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: DPI: 90 mcg per actuation, 180 mcg per actuation
asthma, maintenance tx
- [6 yo and older]
- Dose: 1-2 puffs inhaled bid; Start: varies by disease severity and current asthma tx, may incr. dose after 1-2wk; Max: 720 mcg/day; Info: taper to lowest effective dose; search 'asthma' for epocrates Asthma Long-Term Management NIH/NHLBI decision tools
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to milk protein, severe
- status asthmaticus
- asthma, acute
- bronchospasm, acute
- caution: hypersensitivity to corticosteroids
- caution: peds patients
- caution: adolescent patients
- caution: hepatic impairment
- caution: long-term systemic corticosteroid use, recent
- caution: immunosuppressed patients
- caution: infection, active
- caution: TB infection, active
- caution: TB infection, latent
- caution: measles exposure
- caution: varicella exposure
- caution: osteoporosis
- caution: osteoporosis risk
- caution: cataract
- caution: glaucoma
- caution: glaucoma risk
- caution: ocular HSV
Drug Interactions .
Overview
budesonide inhaled
corticosteroid inhaled
- CYP3A4 substrate
- immunomodulatory effects
- interferes w/ ACTH analog test
Contraindicated
- desmopressin
Avoid/Use Alternative
- budesonide inhaled
- cladribine oral
- cobicistat
- darunavir
- lopinavir/ritonavir
- natalizumab
- pimecrolimus topical
- ritonavir
Monitor/Modify Tx
- carfilzomib
- cosyntropin
- everolimus
- metyrapone
- mitomycin
Caution Advised
- abatacept
- abemaciclib
- abrocitinib
- acalabrutinib
- adagrasib
- adalimumab
- afamitresgene autoleucel
- aldesleukin
- alemtuzumab
- anakinra
- anifrolumab
- anti-thymocyte globulin
- atazanavir
- atidarsagene autotemcel
- avacopan
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- baricitinib
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- belinostat
- bendamustine
- betamethasone
- bimekizumab
- blinatumomab
- bortezomib
- brentuximab vedotin
- brexucabtagene autoleucel
- brodalumab
- budesonide
- budesonide nasal
- budesonide rectal
- busulfan
- cabazitaxel
- canakinumab
- carboplatin
- carmustine
- ceritinib
- certolizumab pegol
- chlorambucil
- chloramphenicol
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clarithromycin
- clobetasol ophthalmic
- clofarabine
- copanlisib
- corticotropin
- cortisone
- crovalimab
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- decitabine
- deflazacort
- delgocitinib topical
- deucravacitinib
- deuruxolitinib
- dexamethasone
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- dinutuximab
- diroximel fumarate
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- emapalumab
- epcoritamab
- epirubicin
- eribulin
- etanercept
- etoposide
- etrasimod
- etuvetidigene autotemcel
- fingolimod
- floxuridine
- fludarabine
- fludrocortisone
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- fruquintinib
- gemtuzumab ozogamicin
- glofitamab
- golimumab
- guselkumab
- hydrocortisone
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- ibrutinib
- icotrokinra
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inebilizumab
- infliximab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- itraconazole
- ixabepilone
- ixekizumab
- ketoconazole
- lebrikizumab
- leflunomide
- lenalidomide
- levoketoconazole
- linvoseltamab
- lisocabtagene maraleucel
- lomustine
- lonafarnib
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methacholine inhaled
- methotrexate
- methylprednisolone
- mifepristone
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- narsoplimab
- nefazodone
- nelarabine
- nelfinavir
- nipocalimab
- obecabtagene autoleucel
- obinutuzumab
- ocrelizumab
- ofatumumab
- oxaliplatin
- ozanimod
- paclitaxel
- pegcetacoplan
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- ponesimod
- posaconazole
- pozelimab
- prednisolone
- prednisolone ophthalmic
- prednisone
- procarbazine
- quizartinib
- ravulizumab
- regorafenib
- ribociclib
- rilonacept
- rilzabrutinib
- risankizumab
- ritlecitinib
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- ruxolitinib topical
- sarilumab
- satralizumab
- secukinumab
- selinexor
- sibeprenlimab
- siltuximab
- siponimod
- sirolimus
- sirolimus albumin-bound
- spesolimab
- sulfasalazine
- sutimlimab
- tacrolimus
- tafasitamab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- temsirolimus
- teplizumab
- teriflunomide
- thioguanine
- thiotepa
- tildrakizumab
- tipranavir
- tisagenlecleucel
- tocilizumab
- tofacitinib
- topotecan
- trabectedin
- tralokinumab
- triamcinolone
- tucatinib
- ublituximab
- upadacitinib
- ustekinumab
- vamorolone
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- voriconazole
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- bronchospasm
- eosinophilia
- Churg-Strauss syndrome
- adrenal suppression (long-term use)
- hypercorticism (long-term use)
- immunosuppression (long-term use)
- glaucoma (long-term use)
- cataracts (long-term use)
- osteoporosis (long-term use)
- growth suppression (long-term use in peds patients)
Common Reactions
- nasopharyngitis
- nasal congestion
- pharyngitis
- rhinitis
- respiratory infection
- nausea
- gastroenteritis
- otitis media
- candidiasis, oral
- sinusitis
- headache
- pain, non-specific
- back pain
- fever
- neck pain
- syncope
- abdominal pain
- xerostomia
- vomiting
- weight gain
- fractures
- myalgia
- hypertonia
- migraine
- ecchymosis
- insomnia
- dysgeusia
- voice changes
- asthenia
- cough
Safety/Monitoring .
Monitoring Parameters
BMD at baseline if osteoporosis risk factors, then periodically; height in children/adolescents; oral cavity exam periodically; consider ophthalmic exam if long-term use, change in vision, IOP/glaucoma/cataracts history
Look/Sound-Alike Drug Names
Pulmicort confused with: Pulmozyme
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; drug of choice for asthma use during pregnancy; risk of teratogenicity low based on human data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm based on human data and minimal drug excretion into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for budesonide: liver extensively; CYP450: 3A4 substrate
Excretion: for budesonide: urine 60% (none unchanged), feces; Half-life: 2-3h
Subclass: Corticosteroids, Inhaled
Mechanism of Action
for budesonide: exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
Formulary .
No Formulary Selected
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