Intranasal corticosteroid Pregnancy: Considered safe at low doses. Minimal systemic absorption at standard doses.

Budesonide Nasal Spray

Brand names: Rhinocort Aqua, Benacort

Adult dose

Dose: 256 micrograms (2 sprays each nostril) once daily; or 128 micrograms (1 spray each nostril) twice daily

Route: Intranasal

Frequency: Once daily (morning)

Max: 256 micrograms/day (standard); 400 micrograms/day (severe AR)

Allergic rhinitis (AR): 256 mcg OD (2 sprays per nostril). Once symptoms controlled, reduce to 128 mcg/day (minimum effective dose). Nasal polyps: 256 mcg per nostril OD. Take 15 min before exposure to allergen if seasonal.

Paediatric dose

Route: Intranasal

Frequency: Once daily

Max: 128 micrograms/day (children <12 years)

6–11 years: 64–128 mcg/day (1 spray per nostril OD). ≥12 years: adult dose. Mometasone (Nasonex) or fluticasone (Flixonase) often preferred in children (less bioavailability). Use lowest effective dose.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Use with caution in severe hepatic impairment; increased systemic absorption.

Clinical pearls

Correct technique: tilt head forward, aim away from nasal septum (toward outer nostril wall)
Onset of action: 2–3 days minimum; full effect: 1–2 weeks — patient must persist
Preferred over antihistamines for moderate-severe persistent allergic rhinitis
Mometasone has lowest bioavailability (<1%) — safest in children and for long-term use
Combine with oral antihistamine for severe seasonal AR or if eye symptoms

Contraindications

Hypersensitivity to budesonide
Recent nasal surgery (until healed)

Side effects

Nasal irritation and stinging
Epistaxis (nasal bleeding)
Headache
Nasopharyngitis
Nasal septal perforation (rare — if incorrectly aimed)
HPA axis suppression (rare — with very high doses or nasal polyp doses)

Interactions

Ketoconazole and strong CYP3A4 inhibitors — increased systemic absorption of budesonide

Monitoring

Symptom control
Nasal mucosa inspection (epistaxis)
Height (children on high-dose prolonged treatment)

Reference: BNFc; BNF; ARIA Guidelines; BSACI Allergic Rhinitis Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

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