The dosage of Pulmicort is individual.
Initially, at the beginning of inhaled corticosteroid therapy, for therapy during periods of severe asthma or when scaling down or withdrawing oral corticosteroids, the dosage should be: Adults:
200-800 mcg daily in 2-4 inhalations. More severe cases: Maximum dose of 1600 mcg daily.
Children ≥6 years:
100-800 mcg daily in 2-4 inhalations. Once daily dosing may be considered in patients who require 400 mcg/day.
The maintenance dose should be the lowest possible. It is possible that the patient will not taste or perceive any medicine when Pulmicort Turbuhaler is used; this is because such a small amount of substance is dispensed.
After a single dose an effect may be expected after a few hours. The full therapeutic effect is only achieved after several weeks of treatment. Treatment with Pulmicort Turbuhaler is a prophylactic therapy with no demonstrated effect on acute disorders.
In the case of daily doses up to 1 mg the whole dose may be given in one administration. In the case of higher daily doses the dose is divided into two administrations per day.
Initially the dosage should be: Children from 6 months:
0.25-0.5 mg per day. If necessary, the dose may be increased to 1 mg per day.
1-2 mg per day.
For maintenance treatment: Children from 6 months:
0.25-2 mg per day.
0.5-4 mg per day. In very severe cases the dose may be increased further. (See table.)
Click on icon to see table/diagram/image
The maintenance dose should be the lowest possible.
Following a single dose an effect may be expected after a few hours. The full therapeutic effect is achieved only after a few weeks of treatment. Treatment with Pulmicort is prophylactic therapy with no demonstrated effect on acute disorders.
In patients in whom an increased therapeutic effect is desired, in general an increase of the Pulmicort dose is to be recommended in preference to combination treatment with oral corticosteroids because of the lower risk of systemic side effects.
Patients dependent on oral steroids:
When transfer from oral steroids is initiated the patient must be in a relatively stable condition. A high dose of Pulmicort is given in combination with the previously used oral steroid dose for 10 days. After that, the oral dose should be gradually reduced by e.g. 2.5 mg prednisolone or equivalent per month to the lowest possible level. The oral steroid can often be discontinued entirely.
Since budesonide given as Pulmicort Nebuliser Suspension is deposited in the lungs with the aid of inspiration, it is important that the patient inhales calmly and with even breaths through the mouthpiece of the nebuliser.
There is no experience of treatment of patients with impaired hepatic or renal function. Since budesonide is eliminated predominantly through metabolism in the liver, increased exposure may be expected in patients with severe cirrhosis of the liver.
Instructions for correct use of Pulmicort Turbuhaler:
It is important that the inhaler is used correctly.
Turbuhaler is inspiratory flow-driven which means that, when the patient inhales through the mouthpiece, the substance will follow the inspired air into the airways.
Note: It is important to instruct the patient: To carefully read the instructions for use: "How to use Pulmicort Turbuhaler"; to breathe in forcefully and deeply through the mouthpiece to ensure that an optimal dose is delivered to the lungs; never to breath out through the mouthpiece; to rinse the mouth out with water after inhaling the prescribed dose to minimise the risk of oropharyngeal thrush.
The patient may not taste or feel any medication when using Pulmicort Turbuhaler due to the small amount of drug dispensed.
Instructions for correct use of Pulmicort Nebuliser:
Pulmicort Nebuliser Suspension should be administered via a jet nebuliser equipped with a mouthpiece or suitable facemask. The nebuliser should be connected to an air compressor with an adequate airflow (5-8 l/min), and the fill volume should be 2-4 ml.
Note: It is important to instruct the patient: To carefully read the instructions for use: "How to use Pulmicort Nebuliser"; that Ultrasonic nebulisers are not suitable for the administration of Pulmicort Nebuliser Suspension and therefore are not recommended; Pulmicort Nebuliser Suspension can be mixed with 0.9% saline and with solutions for nebulisation of terbutaline, salbutamol, fenoterol, acetylcysteine, sodium cromoglycate and ipratropium. The admixture should be used within 30 minutes; to rinse the mouth out with water after inhaling the prescribed dose to minimise the risk of oropharyngeal thrush; to wash the facial skin with water after using the face mask to prevent irritation; to adequately clean and maintain the nebuliser according to the manufacturer's instructions.
A facemask can be used for children who cannot breathe in through the mouthpiece.