budesonide inhaler, Pulmicort Turbuhaler, Pulmicort Respules (cont.)

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Pulmicort Respules are used for individuals 12 months to eight years of age. Effects are seen in 2 to 8 days, but maximum effects may not be seen for up to 4 to 6 weeks. Pulmicort Respules are used with a jet nebulizer. They usually are taken as one or two doses for a total of 0.5-1 mg daily.

DRUG INTERACTIONS: Ketoconazole (Nizoral, Extina, Xolegel, Kuric) increases the concentrations in blood of budesonide, and this may lead to an increase in the side effects of budesonide. No drug interactions have been described with inhaled budesonide.

PREGNANCY: When given orally to animals, glucocorticoid steroids similar to budesonide have been shown to cause fetal abnormalities. Studies of pregnant women using inhaled budesonide during early pregnancy, however, do not show an increase in the rate of fetal abnormalities. Nevertheless, since these studies cannot exclude the possibility of rare effects on the fetus, inhaled budesonide should be used with caution during pregnancy.

NURSING MOTHERS: It is not known if budesonide is secreted in breast milk. Other medications similar to budesonide are indeed secreted in breast milk. It is not known whether the small amounts that may appear in breast milk have effects on the infant.

SIDE EFFECTS: The most commonly noted side effects associated with inhaled budesonide are mild cough or wheezing; these effects may be minimized by using a bronchodilator inhaler, for example, albuterol (Ventolin), prior to the budesonide. Oral candidiasis or thrush (a fungal infection of the throat) may occur in 1 in 25 persons who use budesonide without a spacer device on the inhaler. The risk is even higher with large doses but is less in children than in adults. Hoarseness or sore throat also may occur in 1 in 10 persons. Using a spacer device on the inhaler and washing one's mouth out with water following each use reduces the risk of both thrush and hoarseness. Less commonly, alterations in voice may occur.

High doses of inhaled glucocorticoid steroids may decrease the formation and increase the breakdown of bone leading to weakened bones and ultimately osteoporosis and fractures. High doses may suppress the body's ability to make its own natural glucocorticoid in the adrenal gland. It is possible that these effects are shared by budesonide. People with suppression of their adrenal glands (which can be tested for by the doctor) need increased amounts of glucocorticoid steroids orally or intravenously during periods of high physical stress, for example, during infections, to prevent serious illness and shock.

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