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Pronunciation
(byoo DES oh nide)
U.S. Brand Names
Generic Available
No
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Intranasal: Management of symptoms of seasonal or perennial rhinitis
Canadian labeling: Additional use (not in U.S. labeling): Prevention and treatment of nasal polyps
Nebulization: Maintenance and prophylactic treatment of asthma
Oral capsule: Treatment of active Crohn's disease (mild-to-moderate) involving the ileum and/or ascending colon; maintenance of remission (for up to 3 months) of Crohn's disease (mild-to-moderate) involving the ileum and/or ascending colon
Oral inhalation: Maintenance and prophylactic treatment of asthma; includes patients who require oral corticosteroids and those who may benefit from systemic dose reduction/elimination
Pregnancy Risk Factor
C (capsule)/B (inhalation)
Pregnancy Considerations
Studies of pregnant women using inhaled budesonide have not demonstrated an increased risk of abnormalities. Teratogenic effects were observed in animal studies following oral administration. Hypoadrenalism has been reported in infants whose mothers were using corticosteroids during pregnancy.
Lactation
Enters breast milk/use caution
Breast-Feeding Considerations
Following use of the powder for oral inhalation, ~0.3% to 1% of the maternal dose was found in breast milk. The maximum concentration appeared within 45 minutes of dosing. Plasma budesonide levels obtained from infants ~90 minutes after breast-feeding (~140 minutes after maternal dose) were below the limit of quantification.
Contraindications
Hypersensitivity to budesonide or any component of the formulation
Inhalation: Contraindicated in primary treatment of status asthmaticus, acute episodes of asthma; not for relief of acute bronchospasm
Canadian labeling: Additional contraindications (not in U.S. labeling): Moderate-to-severe bronchiectasis, pulmonary tuberculosis (active or quiescent), untreated respiratory infection (bacterial, fungal, or viral); use of Rhinocort® Aqua™ and Rhinocort® Turbuhaler® in patients <6 years of age
Warnings/Precautions
Concerns related to adverse effects:
• Adrenal suppression: May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms. Patients receiving >20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections. Do not use this product to transfer patients directly from oral corticosteroid therapy.
• Bronchospasm: May occur with wheezing after inhalation; if this occurs stop steroid and treat with a fast-acting bronchodilator (eg, albuterol).
•Delayed wound healing: Avoid nasal corticosteroid use in patients with recent nasal septal ulcers, nasal surgery or nasal trauma until healing has occurred.
• Immunosuppression: Prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox should be avoided; corticosteroids should not be used to treat ocular herpes simplex. Corticosteroids should not be used for cerebral malaria or viral hepatitis. Close observation is required in patients with latent tuberculosis and/or TB reactivity restrict use in active TB (only in conjunction with antituberculosis treatment).
• Kaposi's sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered.
• Local oral infections: Candida albicans infections may occur in the mouth and pharynx; rinsing (and spitting) with water after inhaler use may decrease risk.
• Myopathy: Acute myopathy has been reported with high-dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor creatine kinase; recovery may be delayed.
• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Pre-existing psychiatric conditions may be exacerbated by corticosteroid use.
Disease-related concerns:
• Asthma: Supplemental steroids (oral or parenteral) may be needed during stress or severe asthma attacks. Not to be used in status asthmaticus or for the relief of acute bronchospasm.
• Cardiovascular disease: Use with caution in patients with HF or hypertension; long-term use has been associated with fluid retention and hypertension.
• Diabetes: Use with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia.
• Gastrointestinal disease: Use with caution in patients with GI diseases (diverticulitis, peptic ulcer, ulcerative colitis) due to perforation risk.
• Hepatic impairment: Use with caution in patients with hepatic impairment, including cirrhosis; long-term use has been associated with fluid retention.
• Myasthenia gravis: Use with caution in patients with myasthenia gravis; exacerbation of symptoms has occurred especially during initial treatment with corticosteroids.
• Myocardial infarct (MI): Use with caution following acute MI; corticosteroids have been associated with myocardial rupture.
• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Consider routine eye exams in chronic users.
• Osteoporosis: Use with caution in patients with osteoporosis; high doses and/or long-term use of corticosteroids have been associated with increased bone loss and osteoporotic fractures.
• Renal impairment: Use with caution in patients with renal impairment; fluid retention may occur.
• Seizure disorders: Use with caution in patients with a history of seizure disorder; seizures have been reported with adrenal crisis.
• Thyroid disease: Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in hyperthyroid patients and decreases in hypothyroid ones.
Special populations:
• Elderly: Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.
• Pediatrics: Orally-inhaled and intranasal corticosteroids may cause a reduction in growth velocity in pediatric patients (~1 centimeter per year [range 0.3-1.8 cm per year] and related to dose and duration of exposure). To minimize the systemic effects of orally-inhaled and intranasal corticosteroids, each patient should be titrated to the lowest effective dose. Growth should be routinely monitored in pediatric patients.
Dosage form specific issues:
• Lactose: Pulmicort Flexhaler™ contains lactose; very rare anaphylactic reactions have been reported in patients with severe milk protein allergy.
Other warnings/precautions:
• Discontinuation of therapy: Withdraw systemic therapy with gradual tapering of dose. There have been reports of systemic corticosteroid withdrawal symptoms (eg, joint/muscle pain, lassitude, depression) when withdrawing oral inhalation therapy.
Adverse Reactions
Reaction severity varies by dose and duration; not all adverse reactions have been reported with each dosage form.
>10%:
Central nervous system: Headache (?21%)
Gastrointestinal: Nausea (?11%)
Respiratory: Respiratory infection, rhinitis
Miscellaneous: Symptoms of HPA axis suppression and/or hypercorticism may occur in >10% of patients following administration of dosage forms which result in higher systemic exposure (ie, oral capsule), but may be less frequent than rates observed with comparator drugs (prednisolone). These symptoms may be rare (<1%) following administration via methods which result in lower exposures (topical).
1% to 10%:
Cardiovascular: Chest pain, edema, flushing, hypertension, palpitation, syncope, tachycardia
Central nervous system: Dizziness, dysphonia, emotional lability, fatigue, fever, insomnia, migraine, nervousness, pain, vertigo
Dermatologic: Acne, alopecia, bruising, contact dermatitis, eczema, hirsutism, pruritus, pustular rash, rash, striae
Endocrine & metabolic: Adrenal insufficiency, hypokalemia, menstrual disorder
Gastrointestinal: Abdominal pain, anorexia, diarrhea, dyspepsia, flatulence, gastroenteritis (including viral), oral candidiasis, taste perversion, vomiting, weight gain, xerostomia
Genitourinary: Dysuria, hematuria, nocturia, pyuria
Hematologic: Cervical lymphadenopathy, leukocytosis, purpura
Hepatic: Alkaline phosphatase increased
Neuromuscular & skeletal: Arthralgia, back pain, fracture, hyperkinesis, hypertonia, myalgia, neck pain, paresthesia, weakness
Ocular: Conjunctivitis, eye infection
Otic: Earache, ear infection, external ear infection
Respiratory: Bronchitis, bronchospasm, cough, epistaxis, hoarseness, nasal congestion, nasal irritation, pharyngitis, sinusitis, stridor, throat irritation
Miscellaneous: Abscess, allergic reaction, C-reactive protein increased, erythrocyte sedimentation rate increased, fat distribution (moon face, buffalo hump); flu-like syndrome, herpes simplex, infection, moniliasis, viral infection, voice alteration
<1%, postmarketing, and/or case reports: Aggressive reactions, alopecia, angioedema, anxiety, avascular necrosis of the femoral head, benign intracranial hypertension, bone mineral density decreased, cataracts, depression, dyspnea, glaucoma, growth suppression, hypersensitivity reactions (immediate and delayed [includes rash, contact dermatitis, angioedema, bronchospasm]), hypocorticism, intermenstrual bleeding, irritability, nasal septum perforation, osteoporosis, psychosis, somnolence, urticaria, wheezing (patients with severe milk allergy)
Metabolism/Transport Effects
Substrate of CYP3A4 (major)
Drug Interactions
Amphotericin B: Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy
Antacids: May decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
Antidiabetic Agents: Corticosteroids (Orally Inhaled) may diminish the hypoglycemic effect of Antidiabetic Agents. In some instances, corticosteroid-mediated HPA axis suppression has led to episodes of acute adrenal crisis, which may manifest as enhanced hypoglycemia, particularly in the setting of insulin or other antidiabetic agent use. Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): May decrease the metabolism of Corticosteroids (Orally Inhaled). Risk C: Monitor therapy
Bile Acid Sequestrants: May decrease the absorption of Corticosteroids (Oral). Risk C: Monitor therapy
Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Loop Diuretics: Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Protease Inhibitors: May decrease the metabolism of Corticosteroids (Orally Inhaled). Risk D: Consider therapy modification
Thiazide Diuretics: Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Thiazide Diuretics. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Food: Grapefruit juice may double systemic exposure of orally-administered budesonide. Administration of capsules with a high-fat meal delays peak concentration, but does not alter the extent of absorption.
Storage
Suspension for nebulization: Store upright at 20°C to 25°C (68°F to 77°F). Protect from light. Do not refrigerate or freeze. Once aluminum package is opened, solution should be used within 2 weeks. Continue to protect from light.
Nasal inhaler: Store with valve up at 15°C to 30°C (59°F to 86°F). Protect from high humidity.
Nasal spray: Store with valve up at 20°C to 25°C (68°F to 77°F); do not freeze. Protect from light.
Oral inhaler (Pulmicort Flexhaler™): Store at controlled room temperature of 20°C to 25°C (68°F to 77°F). Protect from moisture.
Mechanism of Action
Controls the rate of protein synthesis; depresses the migration of polymorphonuclear leukocytes, fibroblasts; reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation. Has potent glucocorticoid activity and weak mineralocorticoid activity.
Pharmacodynamics/Kinetics
Onset of action: Pulmicort Respules®: 2-8 days; Rhinocort® Aqua®: ~10 hours; Inhalation: 24 hours
Peak effect: Pulmicort Respules®: 4-6 weeks; Rhinocort® Aqua®: ~2 weeks; Inhalation: 1-2 weeks
Distribution: 2.2-3.9 L/kg
Protein binding: 85% to 90%
Metabolism: Hepatic via CYP3A4 to two metabolites: 16 alpha-hydroxyprednisolone and 6 beta-hydroxybudesonide; minor activity
Bioavailability: Limited by high first-pass effect; Capsule: 9% to 21%; Pulmicort Respules®: 6%; Inhalation: 6% to 13%; Nasal: 34%
Half-life elimination: 2-3.6 hours
Time to peak: Capsule: 0.5-10 hours (variable in Crohn's disease); Pulmicort Respules®: 10-30 minutes; Inhalation: 1-2 hours; Nasal: 1 hour
Excretion: Urine (60%) and feces as metabolites
Dosage
Nasal inhalation:
U.S. labeling (Rhinocort® Aqua®): Rhinitis: Children ?6 years and Adults: 64 mcg/day as a single 32 mcg spray in each nostril. Some patients who do not achieve adequate control may benefit from increased dosage. A reduced dosage may be effective after initial control is achieved.
Maximum dose: Children <12 years: 128 mcg/day; Adults: 256 mcg/day
Canadian labeling:
Rhinocort® Aqua®: Children ?6 years and Adults:
Nasal polyps: 256 mcg/day administered as a single 64 mcg spray in each nostril twice daily
Rhinitis: Initial: 256 mcg/day administered as two 64 mcg sprays in each nostril once daily or a single 64 mcg spray in each nostril twice daily; Maintenance: Individualize, lowest effective dose
Maximum dose: 256 mcg/day
Rhinocort® Turbuhaler®: Children ?6 years and Adults:
Nasal polyps: 100 mcg into each nostril twice daily (maximum: 400 mcg/day)
Rhinitis: Initial: 200 mcg into each nostril once daily; Maintenance: Individualize, lowest effective dose (maximum: 400 mcg/day)
Nebulization: Children 12 months to 8 years: Asthma: Pulmicort Respules®: Titrate to lowest effective dose once patient is stable; start at 0.25 mg/day or use as follows:
Previous therapy of bronchodilators alone: 0.5 mg/day administered as a single dose or divided twice daily (maximum daily dose: 0.5 mg)
Previous therapy of inhaled corticosteroids: 0.5 mg/day administered as a single dose or divided twice daily (maximum daily dose: 1 mg)
Previous therapy of oral corticosteroids: 1 mg/day administered as a single dose or divided twice daily (maximum daily dose: 1 mg)
NIH Asthma Guidelines (NIH, 2007):
Children 0-4 years:
“Low” dose: 0.25-0.5 mg/day
“Medium” dose: >0.5-1 mg/day
“High” dose: >1 mg/day
Children 5-11 years:
“Low” dose: 0.5 mg/day
“Medium” dose: 1 mg/day
“High” dose: 2 mg/day
Oral inhalation: Asthma:
Children ?6 years:
Pulmicort Flexhaler™: Initial: 180 mcg twice daily (some patients may be initiated at 360 mcg twice daily); maximum 360 mcg twice daily
NIH Asthma Guidelines (NIH, 2007) (administer in divided doses twice daily):
Children 5-11 years:
“Low” dose: 180-400 mcg/day
“Medium” dose: >400-800 mcg/day
“High” dose: >800 mcg/day
Children ?12 years: Refer to adult dosing.
Pulmicort® Turbuhaler®: [CAN, not available in the U.S.]: Initial (during periods of severe asthma or when switching from oral corticosteroid therapy): 200-400 mcg daily in 2 divided doses; Maintenance: Individualized, lowest effective dose.
Adults:
Pulmicort Flexhaler™: Initial: 360 mcg twice daily (selected patients may be initiated at 180 mcg twice daily); maximum 720 mcg twice daily
NIH Asthma Guidelines (NIH, 2007) (administer in divided doses twice daily):
“Low” dose: 180-600 mcg/day
“Medium” dose: >600-1200 mcg/day
“High” dose: >1200 mcg/day
Pulmicort® Turbuhaler® [CAN, not available in the U.S.]: Initial (during periods of severe asthma or when switching from oral corticosteroid therapy): 400-2400 mcg daily in 2-4 divided doses; Maintenance: 200-400 mcg twice daily (higher doses may be needed for short periods of time). Note: Patients taking 400 mcg/day may take as a single daily dose
Oral: Crohn's disease (active): Adults: 9 mg once daily in the morning for up to 8 weeks; recurring episodes may be treated with a repeat 8-week course of treatment
Note: Patients receiving CYP3A4 inhibitors should be monitored closely for signs and symptoms of hypercorticism; dosage reduction may be required. If switching from oral prednisolone, prednisolone dosage should be tapered while budesonide (Entocort™ EC) treatment is initiated.
Maintenance of remission: Following treatment of active disease (control of symptoms with CDAI <150), treatment may be continued at a dosage of 6 mg once daily for up to 3 months. If symptom control is maintained for 3 months, tapering of the dosage to complete cessation is recommended. Continued dosing beyond 3 months has not been demonstrated to result in substantial benefit.
Dosage adjustment in hepatic impairment: Monitor closely for signs and symptoms of hypercorticism; dosage reduction may be required.
Administration: Oral
Oral capsule: Capsule should be swallowed whole; do not crush or chew.
Administration: Inhalation
Powder for inhalation:
Pulmicort Flexhaler™: Hold inhaler in upright position (mouthpiece up) to load dose. Do not shake prior to use. Unit should be primed prior to first use only. It will not need primed again, even if not used for a long time. Place mouthpiece between lips and inhale forcefully and deeply. Do not exhale through inhaler; do not use a spacer. Dose indicator does not move with every dose, usually only after 5 doses. Discard when dose indicator reads “0”. Rinse mouth with water after each use to reduce incidence of candidiasis.
Pulmicort Turbuhaler® [CAN, not available in the U.S.]: Hold inhaler in upright position (mouthpiece up) to load dose. Do not shake inhaler after dose is loaded. Unit should be primed prior to first use. Place mouthpiece between lips and inhale forcefully and deeply; mouthpiece should face up. Do not exhale through inhaler; do not use a spacer. When a red mark appears in the dose indicator window, 20 doses are left. When the red mark reaches the bottom of the window, the inhaler should be discarded. Rinse mouth with water after use to reduce incidence of candidiasis.
Rhinocort® Turbuhaler® [CAN, not available in the U.S.]: Hold inhaler in upright position and turn grey grip as far as it will go in one direction and then back to original position. Clicking sound means inhaler is loaded with dose and ready for use. Place nasal adapter into nostril and ensure firm fit. Cover opposite nostril with finger and inhale (sniff) quickly and forcefully. Do not exhale through inhaler. When a red mark appears in the dose indicator window, 20 doses are left. When the red mark reaches the bottom of the window, the inhaler should be discarded
Suspension for nebulization: Shake well before using. Use Pulmicort Respules® with jet nebulizer connected to an air compressor; administer with mouthpiece or facemask. Do not use ultrasonic nebulizer. Do not mix with other medications in nebulizer. Rinse mouth following treatments to decrease risk of oral candidiasis (wash face if using face mask).
Suspension for nasal inhalation: Shake gently before use. Prime before first use; discard after 120 sprays.
Monitoring Parameters
Monitor growth in pediatric patients; blood pressure, serum glucose, weight with high-dose or long-term oral use
Asthma: FEV1, peak flow, and/or other pulmonary function tests
Dietary Considerations
Avoid grapefruit juice when using oral capsules.
Patient Education
Use as directed; do not increase dosage or discontinue abruptly without consulting prescriber. May take 1-2 weeks or longer before full effects are seen. Avoid grapefruit juice while taking this medication. May be more susceptible to infection; avoid exposure to chickenpox and measles unless immunity has been established. If exposure to measles or chickenpox occurs, notify your prescriber immediately. Report acute nervousness or inability to sleep; severe sneezing or nosebleed; respiratory difficulty, sore throat, hoarseness, bronchitis, or bronchospasms; disturbed menstrual pattern; vision changes; loss of taste or smell perception; or worsening of condition or lack of improvement. Regular eye exams should be considered with long-term use (risk of cataracts or glaucoma). Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.
Oral capsule: Swallow whole; do not crush or chew capsule.
Inhalation/nebulization: This is not a bronchodilator and will not relieve acute asthma attacks. It may take several days for you to realize full effects of treatment. If you are also using an inhaled bronchodilator, wait 10 minutes before using this steroid aerosol. Take 5-10 deep breaths. Use inhaler on inspiration. Hold breath for 5-10 seconds after inhalation. Allow 1 full minute between inhalations. You may experience dizziness, anxiety, or blurred vision (rise slowly from sitting or lying position and use caution when driving or engaging in tasks requiring alertness until response to drug is known); or taste disturbance or aftertaste (frequent mouth care and mouth rinses may help). Rinse mouth with water following oral treatments to decrease risk of oral candidiasis (wash face if using a face mask).
Geriatric Considerations
Ensure that patients can correctly use nasal inhaler.
Additional Information
Effects of inhaled/intranasal steroids on growth have been observed in the absence of laboratory evidence of HPA axis suppression, suggesting that growth velocity is a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function. The long-term effects of this reduction in growth velocity associated with orally-inhaled and intranasal corticosteroids, including the impact on final adult height, are unknown. The potential for “catch up” growth following discontinuation of treatment with inhaled corticosteroids has not been adequately studied.
Anesthesia and Critical Care Concerns/Other Considerations
Surgery: For patients who have received oral systemic corticosteroids during the past 6 months and for selected patients on long-term, high-dose, inhaled corticosteroid (ICS), give stress doses of hydrocortisone intravenously during the surgical period and reduce the dose rapidly within 24 hours after surgery (Expert Panel Report 3, 2007). Clinically important adrenal suppression has been reported in patients receiving high doses of an ICS, particularly children.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation), dry throat, abnormal taste, and herpes simplex. Localized infections with Candida albicans or Aspergillus niger have occurred frequently in the mouth and pharynx with repetitive use of oral inhaler of corticosteroids. These infections may require treatment with appropriate antifungal therapy or discontinuance of treatment with corticosteroid inhaler.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause nervousness and insomnia
Mental Health: Effects on Psychiatric Treatment
None reported
Nursing: Physical Assessment/Monitoring
Monitor therapeutic effectiveness and adverse reactions. When changing from systemic steroids to inhalational steroids, taper reduction of systemic medication slowly (may take several months). Growth should be routinely monitored in pediatric patients. Assess knowledge/teach patient appropriate use, interventions to reduce side effects, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [CAN] = Canadian brand name; [DSC] = Discontinued product
Capsule, enteric coated:
Entocort® EC: 3 mg
Powder for nasal inhalation:
Rhinocort® Turbuhaler® [CAN]: 100 mcg/inhalation [delivers 200 metered actuations] [not available in the U.S.]
Powder for oral inhalation:
Pulmicort Flexhaler™: 90 mcg/inhalation (165 mg) [delivers ~80 mcg/inhalation; 60 actuations]
Pulmicort Flexhaler™: 180 mcg/inhalation (225 mg) [delivers ~160 mcg/inhalation; 120 actuations]
Pulmicort Turbuhaler® [CAN]: 100 mcg/inhalation [delivers 200 metered actuations]; 200 mcg/inhalation [delivers 200 metered actuations]; 400 mcg/inhalation [delivers 200 metered actuations] [not available in the U.S.]
Suspension, intranasal [spray]:
Rhinocort® Aqua®: 32 mcg/inhalation (8.6 g) [120 metered actuations]
Rhinocort® Aqua® [CAN]: 64 mcg/inhalation [120 metered actuations] [not available in the U.S.]
Suspension for nebulization:
Pulmicort Respules®: 0.25 mg/2 mL (30s), 0.5 mg/2 mL (30s), 1 mg/2 mL (30s)
Pricing: U.S. (www.drugstore.com)
Capsule, 24-hour (Entocort EC)
3 mg (30): $190.73
Inhalation (Pulmicort Flexhaler)
90 mcg/ACT (1): $99.84
180 mcg/ACT (1): $132.35
Suspension (Pulmicort)
0.25 mg/2 mL (60): $176.96
0.5 mg/2 mL (60): $208.12
Suspension (Rhinocort Aqua)
32 mcg/ACT (8.6): $101.55
References
Expert Panel Report 3, “Guidelines for the Diagnosis and Management of Asthma,” Clinical Practice Guidelines, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 08-4051, prepublication 2007. Available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
McGee S and Hirschmann J, “Use of Corticosteroids in Treating Infectious Diseases,” Arch Intern Med, 2008, 168(10):1034-46.
Todd GR, Acerini CL, Buck JJ, et al, "Acute Adrenal Crisis in Asthmatics Treated With High-Dose Fluticasone Propionate," Eur Respir J, 2002, 19(6):1207-9.
Todd GR, Acerini CL, Ross-Russell R, et al, "Survey of Adrenal Crisis Associated With Inhaled Corticosteroids in the United Kingdom," Arch Dis Child, 2002, 87(6):457-61.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2008
Content last modified August 2008
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