|Reviewed by Dr Simon
Rowley, Dr Innes Asher, Dorothy Cooper
Dose and Administration
- Starting dose 0.5 mg (12 hourly)
for six weeks until improved and stable.
- Usual maintenance dose 0.25 mg 12 hourly.
- If no response increase to 0.5 mg 12 hourly.
- Infants with severe chronic lung
disease with bronchial hyper-reactivity. Consider use via a spacer. Contact
Pharmacy or Asthma Nurse re availability of a spacer.
Contraindications and Precautions
- Known sensitivity to budesonide.
- Caution neonates with fungal and viral
infections in the airways.
- Caution neonates who are being transferred from
oral corticosteroids to budesonide.
- Caution, may need to wean dose, not stop
Budesonide is a potent, nonhalogenated
corticosteroid. Budesonide has shown a favourable relation between local
anti-inflammatory effect and systemic corticoid side effects over a wide dose
range. This is explained by an extensive (90%) first-pass metabolism of
budesonide in the liver after systemic absorption ie any drug deposited on the
oral buccal mucosa will be rapidly eliminated from the body. Budesonide has
shown anti-inflammatory effect and is manifested as decreased bronchial
A proportion of the drug may be swallowed. The
percentage of the inhaled dose reaching the lung will depend upon the method and
delivery of the nebulised budesonide. After a single dose of budesonide,
improvement of the lung function is achieved within a few hours. The duration of
effect is more than 12 hours. Full effect is not achieved until after a couple
Budesonide is protein-bound 88%. Vd is 4.3
L/kg and half-life is 2 hours.
Possible Adverse Effects
- Posterior subcapsular cataracts.
- Mild irritation in the throat.
- Candida infection in the oropharynx.
- Facial skin irritation.
- Bronchoconstriction (rare).
- Gastrointestinal (nausea and vomiting).
- Ideally before starting, do short
- Short Synacthen Test:
Give synacthen as 250 mcg/1.73 m2 injected intramuscularly. Cortisol levels
at "0" minutes and 60 minutes. Repeat synacthen test the day after
budesonide stopped. If response is poor, should repeat 2-4 weeks later.