Budesonide nasal spray – Use, Dosage, Pregnancy, For sinusitis, Irrigation


What is Budesonide nasal spray?

Budesonide nasal spray is an intra nasal spray that contains a man-made corticosteroid called budesonide. It is a spray used to treat seasonal and perennial symptomatic allergy in adult and children 6 years of age and above.


Budesonide nasal spray contains a corticosteroid that helps in reducing the nasal symptoms associated with allergic rhinitis such as inflammation of the inner lining of the nose, stuffy nose, runny nose, itching, and sneezing. Corticosteroids are the hormones that decrease the selling of inner lining of the nose.

The safety and effectiveness of Budesonide Nasal Spray have not been shown in children under 6 years of age.

Budesonide spray: Indications, Side Effects, Warnings, Pregnancy, Reviews


Budesonide nasal spray Brand names

Budesonide nasal spray is available in market under multiple brand names:

  1. US brand name : Rhinocort Aqua Nasal Spray, Rhinocort Allergy Spray
  2. Canadian Brand Name : Gen-Budesonide Aq
  3. Other brand names include: Entocort EC, Uceris, Beconase, Pulmicort and Pulmicort Flexhaler

How Budesonide nasal spray works?

Budesonide is a corticosteroid that possesses glucocorticoid activity and weak mineralocorticoid activity. When compared with cortisol, budesonide found to possess 200 times superior affinity for glucocorticoid receptors and 1000 times higher anti-inflammatory activity. When checked for systemic activity, budesonide found 40 times more potent than cortisol and 25 more potent in the case of subcutaneous activity.

The mechanism of budesonide nasal spray for allergic rhinitis is not known. There are multiple cell types (eg. Mast cells, eosinophils, neutrophils, macrophages, and lymphocytes) and mediators (eg. Histamine, eicosanoids, leukotrienes, and cytokines) responsible for inflammation. These cells are affected by corticosteroids, therefore, reduce the inflammation associated with rhinitis.

Budesonide nasal spray indications

Budesonide is indicated for the treatment of Seasonal or Perennial Allergic Rhinitis. It is beneficial in providing relief from the symptoms of seasonal and year-round allergic rhinitis.

Budesonide Nasal - Side Effects, Dosage, Interactions, Pregnancy, During breastfeeding

Why is this medication prescribed?

Your doctor prescribes you this medication, only if he notice symptoms of allergic rhinitis, such as sneezing, stuffy nose, itchy nose caused by hay fever (caused by pollens) or other allergies caused by pets or dust. Budesonide nasal spray is not prescribed under the common conditions of cold and is not used to treat normal sneezing or a runny nose. Budesonide works by blocking the release of certain allergens or pollens that cause severe allergy symptoms.

Efficacy of budesonide nasal spray for allergy rhinitis

Allergic rhinitis is a medical condition, which is characterized by inflammation of the inner lining of the nose. The first line therapy for the treatment of mild to moderate allergic rhinitis is corticosteroids. Budesonide aqueous nasal spray (BANS) is widely used for the treatment of allergic rhinitis because:

  1. Effective, safe and well tolerated.
  2. Once daily dosing and a low volume of spray.
  3. Ease of administration.
  4. Formulation of BANS is free from chlorofluorocarbon (CFC) propellants, alcohol, benzalkonium chloride and scents.
  5. Beneficial in providing relief in seasonal and perennial allergic rhinitis in as low as 64 mcg i.e. 32 mcg spray per nostril.
  6. It shows no hypothalamic-pituitary-adrenal axis function at doses 4-fold higher than the recommended starting dose
  7. It is quite cost effective as compared to other intranasal corticosteroids.
  8. Efficacy of BANS (64 mcg) is similar to mometasone furoate nasal spray (200 mcg) once daily.
  9. It showed more patient adherence due to sensory attributes, safety measures, low cost and better efficacy.

How long Budesonide nasal spray should be used for allergy rhinitis?

Budesonide nasal spray should be used as per your doctor’s recommendation. The duration of budesonide nasal spray is based upon the medical condition of the patient.

  • Your doctor may advise you to start budesonide nasal spray 2 to 3 weeks earlier than the beginning if hay fever season if you are using it for hay fever. Budesonide is the corticosteroid that takes few days of treatment to show its maximum effect. So, if you take this medicine before the pollen count rise, it will help you to symptoms from developing.
  • Do not forget to take this medication regularly; of you do not see any symptoms. If you missed a dose then take it as soon as you remember it, and do not double up the dose to make up for missed dose.
  • One should not use the spray more than recommendations. Or the long time use of this spray should also be avoided in order to avoid any kind of side effects.

Budesonide nasal spray for nasal polyps efficacy

Budesonide also proved its efficacy in the treatment of nasal polyps associated with allergic rhinitis. Budesonide showed significant improvement in symptoms of nasal polyps such as a sense of smell within 1 to 2 days of the first dose.

In a study, budesonide in a dose of 128 mcg once daily proved effective in the treatment of nasal polyps whereas doses of budesonide nasal spray at increased doses (256 mcg) did not show any additional efficacy in the treatment of nasal polyps.

Budesonide - Side Effects, Uses, Dosage, Overdose, Pregnancy

How long Budesonide nasal spray should be used for nasal polyps

The duration of budesonide nasal spray is based upon the medical condition of the patient.

  • In a case of nasal polyps, one should use Budesonide nasal spray as per doctor’s recommendation because excessive use of the spray can cause serious side effects.
  • Do not forget to take this medication regularly; of you do not see any symptoms. If you missed a dose then take, it as soon as you remember it, and do not double up the dose to make up for missed dose.
  • One should not use the spray more than recommendations. Or the long time use of this spray should also be avoided in order to avoid side effects such as nasal dryness, nasal edema.

Budesonide efficacy for COPD

Budesonide can be used for the treatment of chronic obstructive pulmonary disease (COPD) when inhaled in a form of metered dose inhaler or a dry powder inhaler. Budesonide is known to reduce the inflammation in airways where it reduces swelling and mucus production thereby provides relief in difficult breathing and makes breathing easier.

Budesonide, in the intranasal spray form, can be used to treat the symptoms of COPD. In patients with severe COPD, budesonide known to reduce the number of COPD exacerbations. It is beneficial in reducing chronic bronchitis and frequent exacerbations associated with COPD.

Budesonide when compared with placebo, reduced asthma associated with COPD as well as the frequency of COPD exacerbations.  If you are using budesonide for the treatment of COPD or asthma, you should not discontinue this medication abruptly because a sudden decrease in systemic corticosteroids may cause a severe exacerbation of their symptoms.

Budesonide nasal spray dosage

Budesonide nasal spray is a nasal spray suspension. Each bottle of budesonide nasal spray contains 32 mcg of budesonide and 120 metered spray of medication after priming.

Budesonide nasal spray proper use

Budesonide nasal spray is used to treat nasal allergy symptoms such as a runny nose, nasal congestion, and sneezing. Budesonide spray is an intranasal corticosteroid that acts by contracting the swollen and inflamed nasal tissue, as well as blocks the action of certain cells and chemicals of the immune system.

Can Budesonide cause adrenal insufficiency and why?

When intranasal steroids such as budesonide used more frequently or in the higher doses than recommended doses, it shows systemic corticosteroid side effects such as hypercorticism and adrenal suppression.

When adrenal glands do not make enough steroid hormones, this condition is called as adrenal insufficiency. Symptoms of adrenal insufficiency may include tiredness, weakness, nausea, vomiting and low blood pressure.

As described, budesonide in higher doses can cause adrenal insufficiency, and if you see the symptoms such as tiredness, weakness, nausea and low blood pressure, you should discontinue the budesonide nasal spray slowly with the accepted procedure because abrupt discontinuation can cause withdrawal symptoms.

The withdrawal symptoms may include joint and/or muscular pain, fatigue, weakness, nausea, vomiting, hypotension, lassitude, and depression. Patients previously treated for prolonged periods with systemic corticosteroids should be weaned off slowly when transferred to topical corticosteroids and carefully monitored for acute adrenal insufficiency in response to stress.

Can Budesonide cause tiredness and why?

When administered in higher than recommended doses, budesonide can cause symptoms (tiredness, weakness, nausea, and vomiting) of adrenal suppression. Adrenal suppression can cause adrenal insufficiency. In adrenal insufficiency, the adrenal glands do not produce enough steroid hormones because of which shows the symptoms like tiredness and weakness, nausea, vomiting, and low blood pressure occurs.

Can Budesonide cause an increased risk of infection, loss of bone strength, and cataracts

Budesonide and other steroid reported causing bone diseases. Glucocorticoids were introduced for the treatment of systemic diseases but frequent uses of glucocorticoids cause serious side effects such as osteoporosis and metabolic bone diseases. The appearance of bone disorders among steroid users are as follows:

  • Low mineral bone density: 15.8%
  • Fracture Risk: 75% (with 3 months continuous steroid therapy)

The Effects of Inhaled corticosteroids (ICS) such as budesonide on bone health were severe. It shows poor bone health and reduced quality of life.

Can Budesonide cause ocular herpes and why?

Budesonide nasal spray should be used in patients with eye and ear infections. The corticosteroids such as budesonide can increase the risk of corneal perforation in patients with ocular herpes simplex.

Can Budesonide nasal spray be used during pregnancy?

Budesonide nasal spray can be used in pregnancy only if the benefit outweighs the risk to the mother and the fetus. This medication can be considered for the administration because of lower systemic effects as compared to other oral glucocorticoids. Budesonide nasal spray should be used with caution in pregnancy.

Can budesonide nasal spray be used during breastfeeding?

This medication should use with caution. It is excreted in human milk. It should be used only if benefits outweigh risks.

Budesonide nasal spray side effects

The side effects of budesonide includes:

  • Nausea, vomiting, diarrhea, and constipation
  • Dizziness and headache
  • Upset stomach or stomach pain, gas, and bloating
  • General or joint pain
  • Fatigue
  • Low blood levels of potassium
  • Acne
  • Weakened immune system
  • Bladder or kidney infection

Serious side effects of budesonide include but are not limited to:

  • Cushing’s syndrome (more likely with long-term use)
  • Decreased function of adrenal glands (more likely with long-term use and higher doses)
  • Pressure in the space between the skull and the brain
  • Life-threatening allergic reaction called anaphylaxis in which you may have trouble breathing, the throat closes up, and your skin breaks out into hives

Budesonide nasal spray contraindications

Budesonide nasal spray is contraindicated in patients with hypersensitivity to budesonide and to any of its ingredients.

Budesonide nasal spray interactions

You should always tell your doctor about the other medications that you are taking because there are many medications, even food that can interact inside our body.

Over – the – counter (OTC) medications such as vitamins, dietary supplements, herbals or any drugs can interact with other drugs that you are taking.

You should not take budesonide if you are taking the following drugs:

  • Theracrys (BCG live intravesical)
  • Medications for viruses like Norvir (ritonavir) or Incivek (telaprevir)
  • Diabetes medications like Byetta or Bydureon (exenatide), Precose (acarbose), Amaryl (glimepiride), Diabeta or Glynase (glyburide), and Glucotrol or Glucotrol XL (glipizide)
  • Water pills like Micronizide or Zide (hydrochlorothiazide), bumetanide, Diuril (chlorothiazide), Edecrin (ethacrynic acid), and Zaroxolyn (metolazone)
  • Cordarone, Pacerone, or Nexterone (amiodarone) or Multaq (dronedarone)

If you are taking the budesonide brand Uceris, you should avoid medications for fungal infections like Extena or Ketozole (ketoconazole) and Sporanox or Omnel (itraconazole).

Can I take Budesonide and Alcohol?

Alcohol and budesonide should not be administered concurrently because both budesonide and alcohol can cause dizziness. The consumption of alcohol along with budesonide can worsen the condition. Heavy machinery work and driving should be avoided if alcohol is taken with budesonide.

Can I take grapefruit juice and Budesonide nasal spray?

There is some foods and medication which can interact with budesonide. One should avoid eating grapefruit and drinking grapefruit juice while taking budesonide. The reason behind avoiding the grapefruit and its substitute is grapefruit juice slows down the body’s ability to break down budesonide as a result of which levels of budesonide can rise very high in the bloodstream.

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