In the article, we will consider in detail the composition of Pulmicort and the instructions for it. This is a Swedish anti-inflammatory drug used for inhalation. The medicine is often used not only in accordance with direct medical indications, but also for coughing of various origins in adults and children from 6 months.
Pulmicort composition and release form
This medication is made in the form of a metered-dose suspension of white color, easily resuspended. Budesonide (micronized) in a dosage of 500 ÎĽg per 1 ml acts as the main active element.
Excipients in Pulmicort for inhalation are: disodium edetate, sodium chloride, polysorbate 80, sodium citrate, anhydrous citric acid, purified water.
The drug is packaged in single-dose plastic containers and foil envelopes, as well as in cardboard packaging.
The composition of Pulmicort is described in detail in the instructions.
Pharmacological properties of the drug
It is a glucocorticosteroid for inhalation administration. Budesonide in Pulmicort in the recommended dosages has an anti-inflammatory effect on the bronchi, reduces the severity of symptoms and the frequency of asthma attacks with the lowest frequency of side effects than during the use of systemic corticosteroids. In addition, this medicine reduces the severity of edema of the mucous membrane of the bronchi, mucus production, sputum formation and high reactivity of the respiratory canals. The medication is well tolerated with long-term treatment, does not have mineralocorticoid activity.
The therapeutic effect after inhalation of a single dose of this drug occurs almost immediately and lasts several hours. The maximum result is achieved 1-2 weeks after the treatment. The main substance in the Pulmicort medicine has a preventive effect on the course of the disease and does not affect its acute symptoms.
The dose-dependent effect on the content of cortisol in the urine and plasma during administration of the drug is shown. In the recommended volumes, it has a significantly smaller effect on the functionality of the adrenal glands than Prednisone, as was proved in ACTH tests.
Pharmacokinetic indicators
Budesonide in Pulmicort is rapidly absorbed after inhalation. In adult patients, systemic bioavailability after inhalation through a nebulizer is approximately 15% of the total prescribed dosage and about 40-70% of the received. The maximum plasma level is reached 30 minutes after inhalation.
Binding to plasma proteins averages 90%. Budesonide in the liver undergoes intensive biotransformation with the formation of metabolites with low hormonal activity. The glucocorticoid activity of these substances (16α-hydroxyprednisolone and 6β-hydroxy-budesonide) is less than 1% of the activity of budesonide, which is excreted in the urine in the form of conjugated or unchanged metabolites. The substance has a high clearance (1.2 l / min).
The pharmacokinetic characteristics of budesonide in Pulmicort for inhalation in children and in people with impaired renal function have not been studied.
Indications for appointment
The medicine is prescribed in such cases:
- with bronchial asthma requiring maintenance treatment of corticosteroids;
- in chronic lung obstruction (COPD).
What is the dosage of Pulmicort for inhalation? The instructions will help us understand this issue.
Dosage rules
The dosage of the drug is set individually. If the dose recommended by the doctor is not more than 1 mg / day, it is administered at a time. In the case of the introduction of larger doses of the drug, it is recommended to divide them into 2 inhalations.
The initial dosage for adult patients is 1-2 mg per day. The maintenance dose is 0.5-4 mg per day. With exacerbations, the volume of the drug administered can be increased.
At the age of 6 months or more, the initial dosage is 0.25-0.5 mg per day. If necessary, it is increased to 1 mg per day.
Before using Pulmicort for inhalation, the medication should be diluted with 0.9% sodium chloride solution so that the total volume of the drug is 2 ml.
If it is necessary to obtain an additional therapeutic result, it is possible to recommend an increase in the dose of the drug instead of its combination with GCS for internal use, which is due to the low risk of developing systemic adverse reactions.
This is confirmed by the instructions for Pulmikort for inhalation for adults.
Recommendations to Patients Receiving Oral HSC
The abolition of oral corticosteroids should begin after the stabilization of the patient’s health status. Within 10 days, high doses of Pulmicort are prescribed against the background of the use of GCS in the usual doses. In the future, over the course of a month, the dose of GCS should be gradually reduced to a minimum volume. In many cases, patients manage to completely abandon the use of such medications.
Use with a nebulizer
The use of Pulmicort is carried out by inhalation, using a nebulizer equipped with a special mask and mouthpiece. The device is connected to the compressor to obtain the necessary air flow, the filling volume of the nebulizer container should be at least 2-4 ml. Since the medicine enters the lungs during inhalation, it is important to instruct the patient to inhale the drug through the mouthpiece smoothly and calmly. If the procedure is carried out to the child, and he cannot take a breath by himself, a special mask is used.
The patient should also be informed about the need to read the instructions for use of this medication, as well as that ultrasonic nebulizers are not used for its use in suspension. The suspension must be mixed with a 0.9% sodium chloride solution or with solutions of medicines such as terbutaline, salbutamol, fenoterol, sodium cromoglycate, acetylcysteine ​​and ipratropium bromide. After inhalation, it is recommended to rinse your mouth with water to reduce the likelihood of oropharyngeal candidiasis. To reduce the risk of skin irritation after using the mask, rinse your skin with water. In addition, it is important to know that the prepared suspension of the Pulmicort medication should be used after a maximum of 30 minutes, after which it is considered unsuitable for administration.
It is also recommended that the nebulizer be regularly flushed in accordance with the manufacturer's instructions.
Terms of use
So, how to use Pulmicort for coughing? A container containing a single dose of the drug is marked with a line. If you turn it over, then this line will mean a volume equal to 1 ml. When it is necessary to apply exactly this amount of suspension, the contents of the package are squeezed out until the liquid reaches the level indicated by the line. An open container is stored in a dark place for no more than 12 hours. Before applying the remainder of the liquid, the contents of the plastic container are shaken.
Side effects
Up to 10% of patients who take this drug may experience these side effects:
- Respiratory tract: irritation of the mucous membrane of the pharynx, candidiasis of the oropharynx, cough, dry mouth, hoarseness of the voice, bronchospasm.
- CNS: cephalalgia, nervousness, depression, excessive excitability, impaired behavior are possible.
- Allergic manifestations: angioedema.
- Dermatological reactions: contact dermatitis, urticaria, rash.
- Other symptoms: there may be signs of a general condition disorder caused by systemic exposure to GCS (including increased adrenal function). In some cases, there is the appearance of hemorrhages on the skin, irritation.
Contraindications
The pharmacological preparation Pulmicort is contraindicated for use in such cases:
- age up to 6 months;
- high sensitivity to budesonide.
Patients require more careful monitoring (use of the drug with caution) if they have an active form of pulmonary tuberculosis, fungal, viral, bacterial infections of the respiratory system, cirrhosis.
When using, the possible systemic effects of GCS should be considered.
During pregnancy and lactation
Monitoring of pregnant patients taking budesonide as part of the Pulmicort drug did not reveal the developmental abnormalities in the fetus, but the risk of their occurrence cannot be ruled out. Therefore, during pregnancy, it is recommended to use the minimum effective dosage of the drug.
Budesonide passes into breast milk, but when using Pulmicort in therapeutic doses, no effect on the baby was noted, therefore the drug is approved for administration during breastfeeding.
Special recommendations
In order to minimize the likelihood of a fungal infection of the pharynx, the patient should be instructed on the need for a thorough mouth rinse after each inhalation. In order to prevent skin irritation, wash your face.
The use of budesonide with itraconazole, ketoconazole and other CYP3A4 inhibitors should also be avoided. If such a combination is necessary, it is recommended to increase the interval between medications to the maximum.
Due to the possible risk of decreased adrenal function, special attention should be paid to patients who are transferred from taking systemic corticosteroids to taking Pulmicort. In addition, special attention is required to patients who took high doses of GCS or continuously received the highest inhaled doses of GCS. Under stress, these people may show signs of adrenal insufficiency. In cases of surgical interventions, such patients are recommended to conduct additional treatment with systemic corticosteroids.
During the transition from oral GCS to the Pulmicort medicine, patients may feel previously observed symptoms, such as pain in the joints and muscles. In such situations, it may be necessary to temporarily increase the dosage of corticosteroids for internal use. In some cases, symptoms such as headache, a feeling of fatigue, vomiting, and nausea may occur, indicating GCS deficiency. It is also possible exacerbation of existing rhinitis and eczema, allergic reactions that were previously eliminated through systemic drugs.
What is the dosage of Pulmicort for inhalation for children according to the instructions?
Pediatric Use
The teenager and children receiving GCS therapy (in any form) for a long period of time are advised to regularly monitor growth indicators. When using GCS, it is necessary to assess the ratio of the benefits of using this drug and the potential likelihood of a slowdown in the child.
The appointment of budesonide in a dosage of up to 400 mcg / day in children after 3 years, according to statistical information, did not lead to the development of systemic effects. Biochemical indicators of the systemic effect of the drug can occur when used in a dose of 400 to 800 mcg / day. With an increase in such a dose, systemic effects are quite common.
The use of corticosteroids for the treatment of bronchial asthma can provoke dysplasia. The results of numerous observations of adolescents and children who have been receiving budesonide for a long time (up to 11 years) have proved that growth reaches the expected normal rates for adults. The instructions for Pulmicort must be strictly followed.
Impact on the ability to drive vehicles and dangerous machinery
The drug does not affect the ability to drive a car and other complex mechanisms. The main thing is to find out in advance how much Pulmicort can be consumed per day.
Overdose symptoms
With a pronounced overdose of the drug, clinical symptoms, as a rule, are not observed.
With prolonged inhalation of the drug in doses significantly higher than recommended, the general effects of corticosteroids in the form of suppression of adrenal function and hypercorticism may develop.
Drug interaction
There was no interaction of budesonide in Pulmicort for adults and children with other medications used to eliminate bronchial asthma.
With the combined use of ketoconazole (at a dose of 200 mg per day), it can increase the concentration of budesonide in plasma by an average of 6 times. During the use of ketoconazole 12 hours after budesonide, the level of the latter in plasma increases on average by 3 times. If you need to take budesonide and ketoconazole at the same time, you should increase the time interval between doses of these drugs to the maximum interval. It is also necessary to consider reducing the dosage of budesonide.
Itraconazole, another potential CYP3A4 inhibitor, also significantly increases plasma levels of budesonide. Preliminary inhalation of beta-adrenostimulants helps to expand the bronchi, improve the penetration of budesonide into the respiratory organs and enhance its therapeutic effect.
Phenytoin, phenobarbital, rifampicin with combined use can reduce the effectiveness of the drug Pulmicort, which is due to the induction of microsomal oxidation enzymes.
Estrogens and methandrostenolone enhance the effects of budesonide.
Storage rules
This pharmacological agent should be stored at a temperature not exceeding 30 ° C, in a place inaccessible to children. The shelf life of Pulmicort is 2 years. After opening the laminated envelope, the containers contained in it must be used within 3 months. Containers are stored in an envelope to protect from sunlight. An opened container is used for 12 hours.
When choosing analogues, it is important to understand that the instructions for the use of Pulmicort, the price and reviews of drugs with similar effects do not apply. It is important to get a doctor’s consultation and not to make an independent drug change.
The price in pharmacies ranges from 812 to 1200 rubles.
Analogs
The following medications can be used as analogues of Pulmicort medicine:
- "Benacort" is a budesonide-based product that is available in the form of a solution and powders for inhalation. This analogue is prescribed for bronchial asthma as the main anti-inflammatory drug. Dosages are set individually by the doctor. Treatment with this agent begins at a stable period of the pathological process. The first 2-3 weeks of inhalation are carried out while taking hormonal medications. For children, Benacort is contraindicated. This drug has the same effect, it can be used only from sixteen years.
- Berodual is a medicine that can be used as an analogue of Pulmicort in the treatment of chronic bronchial asthma and obstructive bronchitis. The main active ingredients are ipratropium bromide and phenoterol hydrobromide. The drug is made in the form of a liquid for inhalation. Berodual is a cheaper analogue of Pulmicort and can be prescribed for children from 6 years old.
- “Budenite Steri-Neb” is a glucocorticosteroid medication intended for inhalation procedures. This medication has antiexudative, anti-inflammatory and anti-allergic properties. The drug is based on the active substance budesonide. The medicine is available in the form of a suspension, odorless, and can be used in children from 6 months.
Reviews
Doctors characterize this medication as a good modern medicine for a wide variety of coughs. It is used not only to eliminate asthma attacks, but in the treatment of pathologies such as laryngitis, pharyngitis, when there is a threat of developing false croup. This is especially true for young children, and the main advantage of this tool, according to doctors, is the possibility of its use in infancy.
Patients who used Pulmicort for coughing noted that this medicine helps them well, quickly stops an asthmatic attack, and is convenient to use. The drug is quite expensive, as indicated by patients, but very effective.
We examined the composition of Pulmicort inhalation preparation and instructions for it. We hope the information provided will be useful to you.