budesonide (inhaled)
Brand: Pulmicort, Rhinocort
Prototype: fluticasone-propionate
Drug Class: inhaled corticosteroid
Drug Family: corticosteroid
Subclass: glucocorticoid receptor agonist
Organ Systems: respiratory
Mechanism of Action
Inhaled corticosteroid with significant first-pass metabolism when swallowed; used in asthma (Pulmicort) and allergic rhinitis (Rhinocort); combined with formoterol as Symbicort.
glucocorticoid receptor
Indications
- asthma maintenance
- COPD (combined with formoterol)
- allergic rhinitis
- Crohn disease (oral, enteral — different indication)
Contraindications
- active pulmonary infection
Adverse Effects
Common
- oral candidiasis
- dysphonia
- HPA suppression
Serious
- adrenal crisis
- paradoxical bronchospasm
Pharmacokinetics (ADME)
| Absorption | inhaled: 34-39% systemic bioavailability; extensive first-pass after swallowing |
| Distribution | high local |
| Metabolism | extensive hepatic CYP3A4 |
| Excretion | fecal/renal |
| Half-life | 2-3 hours |
| Onset | days (anti-inflammatory) |
| Peak | 0.5-2 hours |
| Duration | 24 hours |
| Protein Binding | 88% |
| Vd | low systemic |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| strong CYP3A4 inhibitors | increased systemic levels | major |
Nursing Considerations
- Rinse mouth after use
- Symbicort (budesonide/formoterol): GINA-preferred MART rescue and maintenance inhaler
- Available as Flexhaler (breath-actuated) — no spacer needed
- Nebulized form available for young children
Clinical Pearls
- Combined with formoterol in Symbicort for MART strategy in asthma
- High first-pass effect: lower systemic exposure than fluticasone propionate at equivalent doses
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.