KEY DRUG INFORMATION

Generic Name/Trade Name (s):Budesonide Brand Name (s): Pulmicort Respules Pulmicort Flexhaler Drug Classification: anti inflammatories steroidal Mechanism of Action: Potent, locally acting anti-inflammatory and immune modifier. Therapeutic Effect(s): Decreases frequency/severity of asthma attacks. Improves asthma symptoms

Dosage/Routes: Flexhaler Inhaln (Adults): 180360 mcg twice daily (not to exceed 720 mcg twice daily). (Children 6 yr): 180360 mcg twice daily (not to exceed 360 mcg twice daily).Respules Inhaln (Children 18 yr): Previously on bronchodilators alone0.5 mg once daily or 0.25 mg twice daily (not to exceed 0.5 mg/day); Previously on other inhaled corticosteroids0.5 mg once daily or 0.25 mg twice daily (not to exceed 1 mg/day); Previously on oral corticosteroids1 mg once daily or 0.5 mg twice daily (not to exceed 1 mg/day).. Interactions: Drug-Drug Strong CYP3A4 inhibitors , including ritonavir , atazanavir , clarithromycin , indinavir , itraconazole , ketoconazole , nefazodone , nelfinavir , saquinavir , and telithromycin metabolism and levels of budesonide. Cautions/Precautions (Be sure to address use in pregnancy): Contraindicated in: Hypersensitivity to budesonide; Acute attack of asthma/status asthmaticus. Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (from disease or concurrent therapy); Systemic corticosteroid therapy (should not be abruptly discontinued when inhaled therapy is started; additional corticosteroids needed during stress or trauma); OB: Has been used safely; use only if clearly needed; Lactation: Effects on infant are not known; Pedi: Higher than recommended doses can lead to suppression of hypothalamic-pituitary-adrenal (HPA) function and suppression of linear growth .Adverse Reactions/Side Effects headache. rash. otitis media, dysphonia, epistaxis, oropharyngeal fungal infections, pharyngitis, rhinitis, sinusitis. bronchospasm, cough. abdominal pain, diarrhea, dyspepsia, gastroenteritis, nausea, vomiting. adrenal suppression (high dose, long-term therapy only), growth (children), weight gain. back pain. ANAPHYLAXIS, flu-like syndrome. Nursing Implications After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount required to control symptoms. Gradually decrease dose every 24 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose. Inhaln: Allow at least 1 min between inhalations of Flexhaler. Do not shake inhaler or use with spacer. Intranasal: Clear nasal passage by blowing nose prior to use, shake canister gently before use. PO: May administer without regard to meals, do not chew, crush or break open capsule, swallow whole. Do not administer with grapefruit juice.

*CAPITALS indicates life-threatening. *italic indicates most frequent.