Introduction
Pulmicort is used to prevent the symptoms of asthma (wheezing and shortness of breath). It is a steroid and is known as a "preventer". You need to have a fast-acting “reliever” as well because this medicine will not stop an asthma attack that has already started.
Your doctor will tell you how often you need to use Pulmicort. It is important that you take the lowest dose needed to effectively control your asthma. The effect of this medicine may be noticeable after a few days but will only reach its maximum after a few weeks. This medicine must be used regularly to be effective, so go on taking it even if you do not have any symptoms. No symptoms mean that the medicine is doing its job. If you stop taking it your asthma may get worse. It should not be used to relieve sudden asthma attacks. If an asthma attack occurs, use your quick-relief inhaler "reliever". To get the benefit from this medicine you need to make sure you get your inhaler technique right, otherwise, it will not work as well.
The most common side effects are irritation in the throat, difficulty swallowing and fungal infections in the mouth or throat. If you get these, do not stop taking it but do talk to your doctor. You can help prevent these symptoms by rinsing your mouth and throat with water or brushing your teeth after using your inhaler. There are other rare, side effects which can be serious. Talk to your doctor if you are worried about them. In general, you should be trying to avoid situations which make your asthma worse (your triggers) and try not to smoke.
Before taking Pulmicort, you should tell your doctor if you have tuberculosis, any infections in your mouth or lungs, or liver disease. While taking it you may be more at risk of getting infections so stay away from people with colds and flu. If you use Pulmicort for a long time it may cause weak bones (osteoporosis) and damage to your eyes (glaucoma or cataracts). You might need tests for bone density and eye pressure. Ask your doctor whether it's safe to take this medicine if you are pregnant or breastfeeding.
Side effects of Pulmicort
Common
- Difficulty in swallowing
- Fungal infection
- Respiratory tract infection
How to use Pulmicort
Check the label for directions before use. Shake the inhaler. While you are breathing in from mouth, press down on the inhaler one time to release the medication and hold your breath for 10 seconds. Repeat until you have inhaled the number of puffs as suggested by the doctor.Afterwards, rinse your mouth thoroughly with water and spit it out.
How Pulmicort works
Pulmicort is a steroid. It prevents the cells in the lungs and breathing passages from releasing chemical messengers that cause inflammation (swelling) of the airways. This widens the airways and makes breathing easier.
What if you forget to take Pulmicort?
If you miss a dose of Pulmicort, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Indication
Hay fever, nasal polyposis, seasonal and perennial allergic rhinitis, vasomotor rhinitis
Adult Dose
Nasal
Nasal polyps
Adult: As metered-dose spray (64 mcg or 100 mcg/dose): 1 spray into each nostril bid up to 3 mth; alternatively, 2 sprays into each nostril once daily for preparations containing 64 mcg/dose.
Allergic rhinitis
Adult: As metered-dose spray (64 mcg or 100 mcg/dose): Initially, 2 sprays into each nostril daily or 1 spray into each nostril bid, reduce to 1 spray into each nostril daily until symptoms are controlled.
Child Dose
Nasal
Nasal polyps
Child: >6 yr: As metered-dose spray (100 mcg/dose): 1 spray into each nostril bid up to 3 mth.
Nasal
Allergic rhinitis
Child: >6 yr: As metered-dose spray (100 mcg/dose): Initially, 2 sprays into each nostril daily or 1 spray into each nostril bid, reduce to 1 spray into each nostril daily until symptoms are controlled.
<6 years: Safety and efficacy not established
Contraindication
Hypersensitivity to any of the ingredients of this preparation.
Mode of Action
Budesonide is a corticosteroid that has mainly glucocorticoid activity. It prevents and controls inflammation by controlling the rate of protein syntheis, decreasing the migration of polymorphonuclear leucocytes/fibroblasts and reversing capillary permeability.
Precaution
Budesonide nasal spray should be used with caution in patients with active or quiescent tuberculous infection, untreated fungal, bacterial, or systemic viral infections, or ocular herpes simplex infection. Patients with recent nasal septal ulcers, nasal surgery, or nasal trauma should not use a nasal corticosteroid.
Lactation: Distributed in breast milk; estimated total daily oral dose of budesonide available in breast milk to infant is ~0.3-1% of dose inhaled by mother
Side Effect
1-10%
Epistaxis (8%),Pharyngitis (4%),Bronchospasm (2%),Cough (2%),Nasal irritation (2%)
Pregnancy Category Note
Pregnancy
Adverse events (eg, hypoadrenalism) observed with systemic corticosteroids in animal reproduction studies
Increased risk of abnormalities has not been demonstrated in pregnant women using intranasal budesonide
Clinical considerations: Intranasal corticosteroids are recommended for allergic rhinitis during pregnancy
Lactation
Excreted in breast milk after oral inhalation (~0.3-1% of the maternal dose)
Plasma budesonide levels obtained from infants after breast-feeding were below the limit of quantification
Interaction
The main route of metabolism of corticosteroids, including budesonide, is via cytochrome P450 (CYP) isoenzyme 3A4 (CYP3A4). After oral administration of ketoconazole, a strong inhibitor of CYP3A4, the mean plasma concentration of orally administered budesonide increased. Concomitant administration of CYP3A4 may inhibit the metabolism of, and increase the systemic exposure to, budesonide. Caution should be exercised when considering the co-administration of Budesonide Nasal Spray with long-term ketoconazole and other known strong CYP3A4 inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin).