Intranasal corticosteroid Pregnancy: Prospective epidemiological studies and worldwide post-marketing experience indicate no increased risk for overall congenital malformations from inhaled or intranasal budesonide in early pregnancy. Budesonide is excreted in breast milk, but at therapeutic intranasal doses no effects on the breast-fed infant are anticipated (maternal systemic exposure is low) and the medicine may therefore be considered for use during breast-feeding.

Budesonide Nasal Spray

Brand names: Rhinocort Aqua, Benacort

Used in: Inflammatory Bowel Disease

Budesonide nasal spray is an intranasal corticosteroid used for the prevention and treatment of allergic and non-allergic rhinitis and as medical therapy for nasal polyps.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 256 micrograms per day (start dose) - either two applications of 64 micrograms into each nostril each morning, or one application of 64 micrograms into each nostril morning and evening

Route: Nasal (intranasal spray)

Frequency: Once daily (morning) or twice daily (morning and evening)

Rhinitis in adults including the elderly. Dosage should be individualised. Recommended start dose 256 micrograms per day; if good effect is achieved, reduce to one application of 64 micrograms into each nostril each morning. The full effect is not achieved until after a few days of treatment. Treatment of seasonal rhinitis should, if possible, start before exposure to the allergens. If symptoms are not controlled, or persist for longer than 2 weeks of treatment, medical advice must be sought. This medicine should not be used continuously for longer than 3 months. Titrate to the lowest dose at which effective control of symptoms is achieved. Paediatric population: this spray should not be used in children and adolescents under 18 years of age. Reduced liver function lowers the elimination rate of corticosteroids and increases systemic exposure - be aware of possible systemic side effects. Product: Benacort 64 micrograms Nasal Spray.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Epistaxis (common)
Haemorrhagic secretion (common)
Nasal discomfort - sneezing, stinging and dryness (common)
Hypersensitivity, immediate and delayed, including erythema, urticaria, rash, dermatitis, angioedema and pruritus (uncommon)
Signs and symptoms of systemic corticosteroid effects, including adrenal suppression and growth retardation (rare)
Nasal septum perforation, nasal ulcer, dysphonia, blurred vision (rare)

Interactions

CYP3A inhibitors, including cobicistat-containing products - expected to increase the risk of systemic corticosteroid side effects; the combination should be avoided unless the benefit outweighs the risk, in which case monitor for systemic corticosteroid side effects (stated in SPC section 4.4; section 4.5 was not captured in the fetched extract)

Clinical monograph

How it works

Budesonide is a glucocorticoid that suppresses inflammatory mediators in the nasal mucosa, reducing congestion, rhinorrhoea, sneezing and polyp-related obstruction with limited systemic exposure.

Prescribing in practice

Local effects such as nasal dryness, irritation and epistaxis are common, and nasal septal perforation has been reported rarely, so correct spray technique aimed away from the septum is important.
Maximum benefit in allergic rhinitis is achieved with regular continued use rather than occasional dosing, ideally started before the allergen season.
Prolonged high-dose intranasal corticosteroid use, especially with other steroid routes, carries a small risk of systemic effects, and growth should be monitored in children on long-term treatment.

Monitoring

For long-term use review nasal mucosal health and symptom control, and monitor growth in children receiving prolonged therapy.

Counselling the patient

Use every day as prescribed for best effect, even when symptoms are mild.
Aim the spray slightly outward, away from the central wall of the nose.
Report persistent nosebleeds or crusting.

Evidence & guidelines

Intranasal corticosteroids such as budesonide are first-line treatment for moderate-to-severe allergic rhinitis in NICE and allergy guidance.

Reference: ARIA Guidelines; BSACI Allergic Rhinitis Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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