Budesonide

Source SPC is Budesonide 0.5 mg nebuliser suspension. Dosage adjusted to individual need and reduced to the minimum needed to maintain good asthma control. Adults (including elderly) and children 12 years and older: dosage as adults — initiation usually 1-2 mg twice daily, maintenance 0.5-1 mg twice daily. Transfer from oral corticosteroids: patient should be in a relatively stable phase; give a high dose of nebulised budesonide with the previous oral steroid dose for about 10 days, then gradually reduce the oral steroid (e.g. by 2.5 mg prednisolone or equivalent each month) to the lowest possible level. Use ultrasonic nebulisers are NOT suitable; can be mixed with 0.9% saline and with terbutaline, salbutamol, fenoterol, acetylcysteine, sodium cromoglycate or ipratropium nebuliser solutions (use admixture within 30 minutes). Advise mouth rinsing with water after inhaling to reduce oropharyngeal candidiasis; wash facial skin after face-mask use. PAEDIATRIC (nebuliser suspension): children 3 months to 12 years — initiation 0.5-1 mg twice daily, maintenance 0.25-0.5 mg twice daily; highest dose 2 mg/day only for severe asthma and limited periods. Croup (infants and children): usual dose 2 mg nebulised budesonide as a single administration OR as two 1 mg doses separated by 30 minutes; can be repeated every 12 hours for a maximum of 36 hours or until clinical improvement. Doses are fixed by age/indication (not per-kg). NB the openFDA (US) label captured is a different product — an OTC intranasal spray for allergic rhinitis (adults/children >=12: 2 sprays per nostril once daily; children 6 to <12: 1 spray per nostril once daily) — do not conflate with the UK nebuliser posology.