Budesonide nasal

Budesonide nasal spray one spray each nostril daily... 

Budesonide nasal spray is available for the treatment of seasonal and perennial allergic rhinitis in adults and children. 

Gastpar H, Aurich R, Petzold U, Dorow P, Enzmann H, Gering R, Kochy HP, Philippe A, Renz W, Wendenburg G. Intranasal treatment of perennial allergic rhinitis. Comparison of azelastine nasal spray and budesonide nasal aerosol. Arzneimittelforschung 1993 43(4) 475-9. 

Budesonide nasal aerosol is supplied as a micronized suspension using a chlorofluorocarbon propellant, which delivers 32 pg from the nasal adapter supplied per metered spray. The total daily adult dose for budesonide is 256 pg. Budesonide powder for pulmonary inhalation uses micronized dry powder in a turboinhaler (DPI) that delivers 200 pg per metered sprayed. The total daily adult dose for budesonide from the DPI is 200 to 800 pg. Full benefit is attained in approximately 1 to 2 weeks. 

Immunologic Topical corticosteroids have been previously implicated in allergic contact dermatitis, but only rarely in systematic allergic reaction. Lips, nose, and eyelid angioedema and pruritic urticarial papules in face, chest, and arms of a 34 year old nonatopic woman were attributed to nasal budesonide, which was administered for common cold [32 ]. The adverse effects developed 8 h after the second administration of 256 gg of budesonide nasally (two puffs per nostril) and remitted gradually over 3-4 days and after treatment with hydroxyzine. Previously the patient had tolerated nasal budesonide without adverse effects. This case of systemic allergic reaction was confirmed by positive results in patch and intradermal test and without cross-reactivity with others corticosteroids. 

Intranasal corticosteroids are the most effective treatment for allergic rhinitis during pregnancy. Beclomethasone and budesonide have been used most. Nasal cromolyn and first-generation antihistamines (chlorpheniramine, tripelennamine, and hydroxyzine) are also considered first-line therapy. Loratadine and cetirizine have not been as extensively studied. 

Figure 9.1 Relationship between the transepithelial electrical resistance (TEER) value of the passage-cultured human nasal epithelial cell layer and permeability of 14C-mannitol (o, passage-2 A, passage-3 , passage-4) and budesonide ( , passage-2 , passage-3 , passage-4). (Data from Ref. [40]).

Table 9.1 Apparent permeability coefficients (Papp) of 14C-mannitol and budesonide across the passage-cultured human nasal epithelial cell layer grown under AIC or LCC conditions for 7 days.

Nakamura et al. [54] deseribe a mieropartieulate dosage form of budesonide, consisting of novel bioadhesive and pH-dependent graft copolymers of polymethacrylic acid and polyethylene glycol, resulting in elevated and constant plasma levels of budesonide for 8 hr after nasal administration in rabbits. 

Nakamura, K., Maitani, Y., Lowman, A.M., Takayama, K., Peppas, N.A., and Nagai, T., Uptake and release of budesonide from mueoadhesive, pH-sensitive copolymers and their application to nasal delivery, J. Control. Rel. 61 329-335 (1999). 

Rhinocort Aqua and Nasonex are preparations containing topical nasal corticosteroids (budesonide and mometasone furoate respectively). Otrivine contains a nasal decongestant (xylometazoline) and Sudafed is a systemic preparation containing a nasal decongestant (phenylephrine). Molcer is a preparation for ear-wax removal and which contains docusate sodium. Emadine contains an antihistamine (emedastine) and is presented as eye drops. 

Rhinocort Aqua is the proprietary preparation of a topical nasal spray containing the corticosteroid budesonide and is marketed by AstraZeneca. 

Sodium chloride 0.9% is safe and effective in relieving rhinorrhoea. It is safer to use in children than topical nasal decongestants (xylometazoline), which are to be avoided in children under 6 years as the latter are more likely are cause side-effects (such as effects on sleep or hallucinations). Budesonide spray is used for allergic conditions and is not normally used in paediatric patients. Benzydamine spray is a throat spray intended to relieve pain in the throat. Mupirocin is indicated for staphylococcal infections. 

Beclomethasone dipropionate, triamcinolone acetonide, budesonide, flunisolide, and mometasone furoate are available as nasal sprays for the topical treatment of allergic rhinitis. They are effective at doses (one or two sprays one, two, or three times daily) that in most patients result in plasma levels that are too low to influence adrenal function or have any other systemic effects. 

Nasal budesonide or beclomethasone 100 micrograms bd for 3-9 months had no effect on the eyes in 26 patients who had undergone endoscopic sinus surgery (440). Ophthalmologic examination, tonometry, visual field testing, and biomicroscopic studies showed no evidence of ocular hypertension or posterior subcapsular cataract. 

The effects of budesonide aqueous nasal spray (64 micrograms/day) on adrenal function were studied in a 6-week double-blind, placebo-controlled study in 78 patients with allergic rhinitis aged 2-5 years (39). Adrenal function, evaluated by the mean change in morning plasma cortisol concentration after cosyntropin stimulation, was not suppressed. This dose of budesonide by nasal spray is unlikely to have significant systemic activity. 

Kim KT, Rabinovitch N, Uryniak T, Simpson B, O Dowd L, Casty F. Effect of budesonide aqueous nasal spray on hypothalamic-pituitary-adrenal axis function in children with allergic rhinitis. Ann Allergy Asthma Immunol 2004 93 61-7. 

Poon E, Fewings JM. Generalized eczematous reaction to budesonide in a nasal spray with cross-reactivity to triamcinolone. Australas J Dermatol 2001 42(l) 36-7. 

In 1987 the xanthine derivative theophylline was the most commonly used medication in the treatment of asthma, followed by / 2-agonists, such as albuterol or ter-butaline, and inhaled corticosteroids, for example budesonide or flunisolide. Today, the most frequently used medication is inhaled / 2-agonists and it is expected that these therapy patterns have shifted toward greater use of inhaled corticosteroids [4, 5], Nevertheless, whether used alone or in combination with other therapies, corticosteroids do not consistently abrogate airway inflammation in patients with asthma common side effects associated with this type of drug are increased heart rate, nervousness, tremors, nasal irritation, nausea, and headaches [8, 10, 11],... 

Nasal sprays are available as squeeze bottles, which would not be expected to give reproducible dosing. They are also available as metered-dose devices, which would be expected to give more reproducible dosing, as a mechanical actuation delivers a pre-determined volume to the patient. Thus the dose of drag received by the patient will be dependent on the concentration of drag in the formulation. Commercial examples of metered-dose sprays include Syntaris, Beconase and Rhinocort which deliver flunisolide, beclomethasone and budesonide respectively. 

Thorsson, L. Newman, S.P. Weisz, A. Trofast, E. Moren, F. Nasal distribution of budesonide inhaled via a powder inhaler. Rhinology 1993, 31, 7-10. 

Similar complaints regarding taste or smell were noted in some patients when azelastine nasal spray was used alongside budesonide (4) or ebastine (5) in allergic rhinitis in equieffective doses. 

RHINOCORTAQUA AstraZeneca (U.S./UK) Budesonide, micronised SAI, Mr = 430 Na2edta, potassium sorbate, dex, MCC, NaCMC, Tw80, HCI (pH 4.5) Glass bottle, nasal spray 100 p,g actuations... 

---