IT IS USED BY INHALATION IN THE MANAGEMENT OF ASTHMA, IN USUAL DOSES OF 400 MICROGRAMS DAILY IN 2 DIVIDED DOSES FROM A METERED-DOSE AEROSOL; IN SEVERE ASTHMA THE DOSAGE MAY BE INCREASED UP TO A TOTAL OF 1.6 MG DAILY, AND GUIDELINES FOR THE MANAGEMENT OF ASTHMA PERMIT UP TO 2 MG DAILY .MAINTENANCE DOSES MAY BE LESS THAN 400 MICROGRAMS DAILY BUT SHOULD NOT BE BELOW 200 MICROGRAMS DAILY. A DOSE FOR CHILDREN IS 50 TO 400 MICROGRAMS INHALED TWICE DAILY. BUDESONIDE IS ALSO AVAILABLE FOR THE MANAGEMENT OF ASTHMA IN THE FORM OF A DRY POWDER INHALER; DOSES ARE 200 TO 800 MICROGRAMS DAILY, AS 2 DIVIDED DOSES OR A SINGLE DAILY DOSE; UP TO 800 MICROGRAMS TWICE DAILY MAY BE GIVEN TO ADULTS IF NECESSARY. PATIENTS FOR WHOM BUDESONIDE FROM A PRESSURISED INHALER OR DRY POWDER FORMULATION IS UNSATISFACTORY MAY USE A NEBULISED SOLUTION. THE USUAL ADULT DOSAGE BY THIS METHOD IS 1 TO 2 MG INHALED TWICE DAILY. THIS MAY BE INCREASED IF ASTHMA IS SEVERE. MAINTENANCE DOSES ARE 0.5 TO 1 MG INHALED TWICE DAILY. FOR CHILDREN BETWEEN 3 MONTHS AND 12 YEARS OF AGE, AN INITIAL DOSE IS 0.5 TO 1 MG TWICE DAILY WITH A MAINTENANCE DOSE OF 0.25 TO 0.5 MG TWICE DAILY.
BUDESONIDE IS ALSO GIVEN BY INHALATION AS A NEBULISED SOLUTION IN THE MANAGEMENT OF CHILDHOOD CROUP . THE USUAL DOSE IS 2 MG, AS A SINGLE INHALED DOSE OR 2 DOSES OF 1 MG, GIVEN 30 MINUTES APART.
BUDESONIDE IS USED TOPICALLY IN THE TREATMENT OF VARIOUS SKIN DISORDERS, AS A CREAM, LOTION, OR OINTMENT CONTAINING 0.025%. FOR RECOMMENDATIONS CONCERNING THE CORRECT USE OF CORTICOSTEROIDS ON THE SKIN, AND A ROUGH GUIDE TO THE CLINICAL POTENCIES OF TOPICAL CORTICOSTEROIDS.
BUDESONIDE IS ALSO USED INTRANASALLY FOR THE PROPHYLAXIS AND TREATMENT OF RHINITIS. IN THE UK, TWO NASAL SPRAY PREPARATIONS ARE AVAILABLE, ONE CONTAINING 100 MICROGRAMS PER METERED SPRAY, AND ONE CONTAINING 64 MICROGRAMS PER METERED SPRAY. THE INITIAL RECOMMENDED DOSE FOR ADULTS AND CHILDREN OVER 12 YEARS IS EITHER 2 SPRAYS INTO EACH NOSTRIL ONCE DAILY IN THE MORNING, OR 1 SPRAY INTO EACH NOSTRIL TWICE DAILY. THIS MAY BE SUBSEQUENTLY REDUCED TO 1 SPRAY INTO EACH NOSTRIL ONCE DAILY; TREATMENT CAN BE CONTINUED FOR UP TO 3 MONTHS. IN THE USA AND SOME OTHER COUNTRIES, A NASAL SPRAY AND A NASAL INHALER ARE AVAILABLE. THE INTRANASAL DOSE MAY BE EXPRESSED IN MULTIPLES OF 32 MICROGRAMS, WHICH IS THE QUANTITY OF BUDESONIDE DELIVERED FROM THE NASAL ADAPTOR. WHEN GIVEN FROM A NASAL INHALER, THE RECOMMENDED INITIAL DOSE FOR ADULTS AND CHILDREN OVER 6 YEARS IS 4 SPRAYS INTO EACH NOSTRIL IN THE MORNING, OR 2 SPRAYS INTO EACH NOSTRIL TWICE DAILY, TO GIVE A TOTAL DAILY DOSE OF 256 MICROGRAMS DAILY. THIS IS REDUCED TO THE LOWEST DOSE ADEQUATE TO CONTROL SYMPTOMS. IF NO BENEFIT IS SEEN AFTER 3 WEEKS OF TREATMENT, BUDESONIDE SHOULD BE STOPPED. WHEN GIVEN AS AN AQUEOUS NASAL SPRAY, THE RECOMMENDED INITIAL DOSE FOR ADULTS AND CHILDREN OVER 6 YEARS IS 1 SPRAY INTO EACH NOSTRIL ONCE DAILY (64 MICROGRAMS DAILY), INCREASING AS NECESSARY UP TO A MAXIMUM OF 256 MICROGRAMS DAILY FOR ADULTS AND 128 MICROGRAMS DAILY FOR CHILDREN AGED LESS THAN 12 YEARS. BUDESONIDE IS ALSO USED AS A NASAL SPRAY IN THE MANAGEMENT OF NASAL POLYPS . IN THE UK, FOR ADULTS AND CHILDREN OVER 12 YEARS, 1 SPRAY (CONTAINING 64 OR 100 MICROGRAMS, AS ABOVE) IS GIVEN INTO EACH NOSTRIL TWICE DAILY FOR UP TO 3 MONTHS.
LOCAL FORMULATIONS OF BUDESONIDE ARE USED IN THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASE .IN MILD TO MODERATE CROHN'S DISEASE AFFECTING THE ILEUM OR ASCENDING COLON IT IS GIVEN BY MOUTH AS MODIFIED-RELEASE CAPSULES INTENDED FOR A TOPICAL EFFECT ON THE GASTROINTESTINAL TRACT. THE RECOMMENDED DOSE IS 9 MG DAILY FOR ACTIVE DISEASE, AS EITHER A SINGLE DOSE BEFORE BREAKFAST OR IN 3 DIVIDED DOSES ABOUT 30 MINUTES BEFORE MEALS, DEPENDING ON THE PREPARATION. TREATMENT IS GIVEN FOR UP TO 8 WEEKS, AND THE DOSAGE SHOULD BE REDUCED 2 TO 4 WEEKS BEFORE DISCONTINUING THERAPY. FOR RECURRING EPISODES OF ACTIVE CROHN'S DISEASE, AN 8-WEEK COURSE MAY BE REPEATED. AFTER AN 8-WEEK COURSE FOR ACTIVE DISEASE, BUDESONIDE 6 MG ONCE DAILY IS RECOMMENDED FOR MAINTENANCE OF CLINICAL REMISSION, FOR UP TO 3 MONTHS; THEREAFTER, DOSES ARE TAPERED AND THERAPY STOPPED, AS CONTINUED TREATMENT HAS NOT SHOWN SUBSTANTIAL CLINICAL BENEFIT. THERE IS SOME ABSORPTION OF BUDESONIDE FROM THE GASTROINTESTINAL TRACT, AND THE DOSE MAY NEED TO BE REDUCED IN PATIENTS WITH HEPATIC IMPAIRMENT, ESPECIALLY THOSE WITH CIRRHOSIS (SEE ALSO ADMINISTRATION IN HEPATIC IMPAIRMENT). AN ENEMA SOLUTION CONTAINING 0.002% IS ALSO AVAILABLE; IT IS GIVEN AT BEDTIME FOR 4 WEEKS IN THE TREATMENT OF ULCERATIVE COLITIS AT A DOSE OF 2 MG.
LOCAL FORMULATIONS OF BUDESONIDE ARE ALSO USED IN THE MANAGEMENT OF COLLAGENOUS COLITIS. IT IS GIVEN BY MOUTH AS MODIFIED-RELEASE CAPSULES IN A DOSE OF 3 MG THREE TIMES DAILY FOR UP TO 8 WEEKS. THE DOSAGE SHOULD BE REDUCED GRADUALLY DURING THE LAST 2 WEEKS OF THERAPY.