Generic Name
Budesonide
Brand Names
Rhinocort Aqua
Rhinocort Hayfever
Entocir Nasal
Various generics depending on region
Available as over-the-counter or prescription depending on country and indication
Drug Class
Intranasal corticosteroid (INCS)
Topical anti-inflammatory agent
Mechanism of Action
Budesonide is a synthetic corticosteroid with high topical anti-inflammatory activity
It binds to intracellular glucocorticoid receptors in nasal mucosal cells
This leads to suppression of inflammatory cytokines, chemokines, histamine, prostaglandins, and leukotrienes
The result is reduced mucosal inflammation, edema, nasal congestion, and hyperresponsiveness to allergens and irritants
Budesonide has low systemic bioavailability due to poor nasal absorption and extensive first-pass metabolism
Indications
Approved Uses
Seasonal allergic rhinitis (hay fever)
Perennial allergic rhinitis
Non-allergic rhinitis
Nasal polyps (maintenance after surgery or prevention of regrowth)
Chronic rhinosinusitis (with or without polyps)
Vasomotor rhinitis
Off-Label/Investigational
Eosinophilic nasal inflammation
Adjunct in chronic sinusitis with topical nasal irrigation
Post-operative inflammation in nasal cavity following sinus surgery
Dosing and Administration
Adults and Adolescents (≥12 years)
Usual starting dose: 64 mcg to 256 mcg daily
Typical: 128 mcg daily (64 mcg per nostril once daily)
In some cases: 64 mcg per nostril twice daily (maximum 256 mcg/day)
Once symptoms controlled, reduce to lowest effective dose
Children (6–11 years)
Usual dose: 64 mcg once daily (32 mcg per nostril once)
Do not exceed 128 mcg/day
Use under supervision and regular follow-up for growth monitoring
Children under 6 years
Not routinely recommended unless prescribed by specialist
Nasal Polyps (Adults)
128 mcg to 256 mcg per day
May be used in conjunction with saline nasal irrigation or after surgery
Administration Technique
Clear nasal passages before use
Shake bottle gently
Insert nozzle into one nostril while closing the other
Spray while gently inhaling
Do not blow nose immediately after spraying
Wipe nozzle clean and recap after each use
Priming required before first use or after 2 days of non-use
Contraindications
Hypersensitivity to budesonide or formulation components
Recent nasal surgery or trauma (until healing is complete)
Active nasal or sinus infections (unless appropriately treated)
Recurrent nasal bleeding disorders
Children under 6 years (depending on formulation)
Precautions
Systemic corticosteroid effects possible with prolonged use or high doses
Use lowest effective dose for maintenance
May delay healing in nasal surgery or trauma
Monitor growth in children during long-term therapy
Caution in immunocompromised individuals
Avoid in patients with untreated nasal or sinus infections
May mask signs of nasal infections including candidiasis
Periodic nasal mucosa examination recommended in long-term use
Glaucoma and cataract risk in long-term users; monitor in at-risk patients
Adverse Effects
Common
Nasal irritation
Dryness of nasal mucosa
Sneezing after administration
Epistaxis (nosebleeds)
Sore throat
Cough
Headache
Less Common
Crusting or ulceration of nasal septum
Taste or smell disturbances
Nasal septal perforation (rare with prolonged high-dose use)
Hoarseness or voice change (if drips to pharynx)
Systemic Effects (Rare at normal doses)
Adrenal suppression
Delayed growth in children
Glaucoma or cataracts with prolonged use
Cushingoid features if systemic absorption occurs
Infections
Fungal infection (nasal candidiasis)
Increased susceptibility to respiratory infections (rare)
Pregnancy and Lactation
Pregnancy
Considered safe for use during pregnancy when clinically indicated
Minimal systemic absorption limits fetal exposure
Preferred over systemic corticosteroids for rhinitis in pregnancy
Lactation
Excreted in breast milk in very low amounts
Unlikely to cause adverse effects in nursing infants
Can be used during breastfeeding
Use in Special Populations
Pediatrics
Safe and effective for ages ≥6
Long-term use may affect growth velocity
Monitor height periodically in children on prolonged treatment
Elderly
No specific adjustment needed
Ensure proper administration technique
Hepatic Impairment
Systemic exposure may be higher due to reduced first-pass metabolism
Use with caution in severe hepatic dysfunction
Drug Interactions
CYP3A4 Inhibitors (e.g. ketoconazole, ritonavir, itraconazole)
May increase systemic exposure to budesonide
Avoid concurrent use or monitor for systemic corticosteroid effects
Corticosteroids (systemic or inhaled)
Additive effect may increase systemic glucocorticoid load
Monitor for adrenal suppression
Live vaccines
Caution with systemic absorption in immunocompromised patients
Monitoring Parameters
Relief of nasal symptoms (congestion, rhinorrhea, sneezing, itching)
Nasal mucosa (epistaxis, irritation, ulceration)
Growth velocity in pediatric patients
Signs of adrenal insufficiency in prolonged high-dose use
Ocular symptoms in patients with glaucoma or cataract risk
Formulations and Concentrations
Metered-Dose Nasal Spray
32 mcg per spray
60 or 120 sprays per bottle depending on brand
OTC and prescription options available
Nasal Pump Spray
Delivers uniform dose per actuation
Preserved or preservative-free depending on manufacturer
Storage
Store upright at room temperature
Do not freeze
Protect from direct sunlight
Discard after labeled number of sprays even if liquid remains
Patient Counseling Points
Use consistently every day for best effect
Symptom improvement may take several days
Do not exceed recommended dose
Clear nose before use for optimal absorption
Do not share spray with others
Report any persistent nosebleeds or nasal pain
If missed a dose, use it when remembered unless it's almost time for next dose
Seek medical advice if visual disturbances or growth delay noticed
Avoid spraying directly onto nasal septum
Continue use during allergy season unless advised otherwise
Use in conjunction with antihistamines or decongestants if prescribed for severe rhiniti
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