Pulmicort Turbuhaler
Pulmicort Turbuhaler: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Drug interactions
- 14. Analogs
- 15. Terms and conditions of storage
- 16. Terms of dispensing from pharmacies
- 17. Reviews
- 18. Price in pharmacies
Latin name: Pulmicort Turbuhaler
ATX code: R03BA02
Active ingredient: budesonide (budesonide)
Manufacturer: AstraZeneca, AB (AstraZeneca, AB) (Sweden)
Description and photo updated: 30.11.2018
Prices in pharmacies: from 328 rubles.
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Pulmicort Turbuhaler is an inhaled glucocorticosteroid (GCS) for topical use.
Release form and composition
Dosage form - metered powder for inhalation, which is round granules from almost white to white, easily destroyed by any mechanical action (dosage 100 μg - 200 doses in multi-dose inhalers of the turbuhaler type, consisting of a mouthpiece, a dosing device, a tank for desiccant, a container for storing the powder and a lid; in a cardboard box 1 multi-dose inhaler; dosage 200 mcg - 100 and 200 doses in plastic turbuhalers, in a cardboard box 1 multi-dose inhaler; each pack also contains instructions for the use of Pulmicort Turbuhaler).
The active substance in 1 dose of powder: budesonide - 100 or 200 mcg.
Pharmacological properties
Pharmacodynamics
The active ingredient of Pulmicort Turbuhaler is budesonide, a glucocorticosteroid with a strong local anti-inflammatory effect.
The exact mechanism of action of GCS in bronchial asthma is not fully established. The most important are probably the anti-inflammatory property, inhibition of the release of inflammatory mediators and the cytokine-mediated immune response.
The affinity of budesonide for specific glucocorticoid receptors is 15 times higher than that of prednisolone.
The anti-inflammatory effect of Pulmicort Turbuhaler is mediated by a decrease in the degree of airway obstruction with an early and late allergic response. Budesonide reduces airway reactivity in response to inhalation of methacholine and histamine.
The sooner budesonide treatment is started after persistent bronchial asthma is diagnosed, the more improvement in lung function is expected.
Pulmicort Turbuhaler has a dose-dependent effect on the level of cortisone in plasma and urine. In tests for adrenocorticotropic hormone (ACTH tests), it was shown that when used in the recommended doses, budesonide has a significantly smaller effect on adrenal function compared to prednisone at a dose of 10 mg.
Budesonide, used in daily doses of up to 400 mcg in children over 3 years of age, did not cause systemic effects. The development of biochemical signs of systemic action is possible with the use of the drug in daily doses from 400 to 800 mcg, systemic effects often occur when the dose is exceeded 800 mcg per day.
In the course of observations of children and adolescents who received budesonide for a long time (for periods of up to 11 years), it was found that their growth reaches the expected standard indicators. However, the likelihood of a negative effect of budesonide, like other GCS, on the growth of pediatric patients cannot be excluded.
Pulmicort Turbuhaler is effective for the prevention of exercise-induced asthma (when applied 1 or 2 times a day).
Pharmacokinetics
After inhalation, budesonide is rapidly absorbed. About 25–35% of the dose inhaled with Turbuhaler gets into the lungs. The maximum plasma concentration is reached within 30 minutes. Systemic bioavailability is approximately 38%.
Plasma proteins bind 90%. The volume of distribution is about 3 l / kg. After absorption, budesonide is intensely (more than 90%) bound in the liver, resulting in the formation of metabolites with low glucocorticosteroid activity. The activity of the main metabolites 16α-hydroxyprednisolone and 6β-hydroxybudesonide is less than 1% of that of the parent substance.
The drug is metabolized mainly with the participation of the CYP3A4 enzyme.
Metabolites are excreted unchanged in the urine or in conjugated form. In unchanged form, budesonide is excreted in small quantities in the urine.
The systemic clearance of budesonide is about 1.2 l / min. Pharmacokinetic parameters are proportional to the dose used.
In children and patients with functional impairment of the kidneys, the pharmacokinetics of the drug have not been studied. With liver diseases, it is possible to slow down the excretion of budesonide from the body.
Indications for use
- bronchial asthma (if necessary, maintenance therapy with GCS);
- chronic obstructive pulmonary disease.
Contraindications
Absolute:
- age up to 6 years;
- hypersensitivity to the drug.
Relative:
- pulmonary tuberculosis (both active and inactive);
- fungal, bacterial, or viral respiratory infections;
- the period of pregnancy and lactation.
Pulmicort Turbuhaler, instructions for use: method and dosage
Pulmicort Turbuhaler is used by inhalation. The appropriate dose is selected individually.
At the beginning of inhalation therapy in severe exacerbations of bronchial asthma, as well as in case of dose reduction or cancellation of oral GCS, the following daily doses of Pulmicort Turbuhaler are recommended:
children over 6 years old: 100–800 mcg. The transition to a single dose should be carried out under the supervision of a pediatrician;
adults: 200-800 mcg. With a severe exacerbation of the disease, an increase in the daily dose to 1600 mcg is possible.
If the dose exceeds 400 mcg, it can be divided into 2-4 inhalations.
When choosing the optimal maintenance dose, it is recommended to use the minimum effective dose.
The therapeutic effect after the introduction of one dose of the drug develops within a few hours. The maximum stable effect is achieved after 1–2 weeks of therapy. Pulmicort Turbuhaler has a prophylactic effect against bronchial asthma, but does not have a significant effect on acute manifestations of the disease.
When using multi-dose inhalers of the turbuhaler type, a better efficacy of budesonide has been demonstrated compared to using a similar dose when using a metered aerosol. Transfer of a patient from Pulmicort in aerosol form to Pulmicort Turbuhaler requires consideration of the possibility of reducing the dose of the drug. If it is necessary to enhance the therapeutic effect, instead of combining the drug with oral GCS, you can increase the daily dose of Pulmicort Turbuhaler, since in this case the risk of developing systemic effects is lower.
Cancellation of oral corticosteroids is possible only when the patient is stable. It is recommended to use a high dose of Pulmicort Turbuhaler against the background of their usual dose for 10 days. Further, the dose of oral corticosteroids is gradually reduced to the lowest possible. In many cases, they can be completely abandoned.
Instructions for using Pulmicort Turbuhaler
Turbuhaler is a multi-dose inhaler that allows you to dose and inhale the drug in very small doses. It is important to read the enclosed instructions for use carefully before using it.
With active inhalation, the powder is delivered directly to the lungs, so it is important to inhale strongly and deeply through the mouthpiece. Under no circumstances should you exhale through the mouthpiece.
Rules for using Turbuhaler:
- Unscrew and remove the cap.
- Take the inhaler vertically with the dispenser down. Load the dose into the inhaler by turning the dispenser counterclockwise until it stops, and then return it to its original position until it clicks.
- Exhale (not through the mouthpiece).
- Gently squeeze the mouthpiece with your teeth, close your lips, inhale deeply and strongly through your mouth (do not chew the mouthpiece). If more than one inhalation is required, steps 2-4 should be repeated.
- Close the inhaler tightly with the cap.
- Rinse mouth thoroughly with water.
The amount of powder inhaled is very small, after inhalation its taste is not always felt in the mouth. Correct use of Turbuhaler (exactly according to the instructions) guarantees inhalation of the required dose of the drug.
Clean the outside of the mouthpiece with a dry cloth regularly once a week. Do not use water or any other liquid.
When approximately 20 doses remain in the inhaler, a red mark appears in the dose window of the indicator. When it reaches the bottom of the window, the inhaler is empty.
When shaking the inhaler, a sound is heard - it is not produced by the drug, but by the drying agent.
Side effects
- from the respiratory tract: often (> 1/100) - irritation of the pharyngeal mucosa, oropharyngeal candidiasis, hoarseness, cough; rarely (<1/1000) - bronchospasm;
- on the part of the skin: rarely - skin rashes, urticaria, contact dermatitis, bruises on the skin;
- on the part of the psyche and nervous system: rarely - excitability, nervousness, behavioral disturbances, depression;
- other reactions: rarely - angioedema (angioedema of Quincke); symptoms characteristic of the systemic action of glucocorticoids (including hypofunction of the adrenal glands).
Overdose
In cases of overdose of budesonide, clinical manifestations were absent.
With prolonged use of Pulmicort Turbuhaler in excessive doses, a systemic glucocorticoid effect may develop, manifested by hypercorticism and suppression of adrenal function.
special instructions
To avoid the development of fungal infection of the oropharynx, it is recommended to rinse your mouth thoroughly with water after each inhalation.
Special observation is required for patients who are transferred to Pulmicort Turbuhaler from systemic corticosteroids, as well as for patients at risk of impaired pituitary-adrenal function. In these cases, it is necessary to carefully reduce the dose of systemic glucocorticoid and control the hormonal function of the adrenal glands. During stressful situations (for example, with trauma or surgery), oral corticosteroids may be required.
In the process of switching to Pulmicort Turbuhaler from oral corticosteroids, it is possible that previously observed symptoms, such as pain in joints and muscles, may resume. In this case, a temporary increase in the dose of oral corticosteroids may be appropriate. In rare cases, symptoms are observed that indicate systemic insufficiency of adrenal hormones, such as nausea and vomiting, headache, feeling of fatigue.
Replacing oral corticosteroids with inhaled ones is accompanied by a risk of weakening of the pituitary-adrenal function, therefore, intensive monitoring is required. Also, patients who took high doses of GCS or inhaled at recommended doses, but for a long time, should be under special control. In such patients, under stress, signs of adrenal insufficiency may develop. In stressful situations and during surgery, additional therapy with systemic glucocorticoids may be required.
Replacement of oral corticosteroids with inhaled ones is sometimes accompanied by manifestations of concomitant allergies, for example, rhinitis or eczema, which were previously stopped by systemic agents.
Patients should be warned about the need for urgent medical attention if the effectiveness of therapy decreases. You should not independently increase the frequency of taking Pulmicort Turbuhaler, as this may lead to a delay in the appointment of adequate treatment. With a sudden deterioration in the condition, the doctor should consider conducting a course of therapy with oral corticosteroids.
Influence on the ability to drive vehicles and complex mechanisms
Pulmicort Turbuhaler does not have a negative effect on the cognitive and psychomotor abilities of a person.
Application during pregnancy and lactation
According to the results of studies in animals, it has been established that GCS can cause abnormalities in the development of the fetus, however, these data cannot be compared with those in people receiving the drug in recommended doses. In clinical studies of the use of budesonide in pregnant women, an increased risk of fetal abnormalities has not been identified, but the risk cannot be completely ruled out. For this reason, during pregnancy, Pulmicort Turbuhaler is used, but in the minimum effective dose.
It is unknown whether budesonide penetrates into breast milk. During lactation, Pulmicort Turbuhaler can be prescribed only after the balance of benefits and risks.
Pediatric use
The drug is contraindicated in children under 6 years of age.
In children and adolescents who receive Pulmicort Turbuhaler for a long time, it is necessary to regularly monitor growth indicators.
With impaired renal function
There is no information on the use of Pulmicort Turbuhaler in renal failure.
For violations of liver function
There is no information on the use of the drug for liver cirrhosis. But since budesonide is biotransformed in the liver, with severe cirrhosis, an increase in the duration of the action of Pulmicort Turbuhaler is possible.
Drug interactions
With the simultaneous use of other drugs intended for the treatment of bronchial asthma, drug interactions were not observed.
Ketoconazole (in a daily dose of 200 mg) increases the concentration of oral budesonide: in the case of joint administration - 6 times, if the interval between doses is 12 hours - 3 times. There are no data regarding the simultaneous inhalation of budesonide, but the likelihood of a similar effect is assumed. In this regard, the simultaneous use of ketoconazole and Pulmicort Turbuhaler is not recommended. If combination therapy is clinically justified, it is necessary to increase the time between drugs to the maximum possible, and also consider reducing the dose of budesonide. Other potential inhibitors of the CYP3A4 enzyme (for example, itraconazole) are also able to significantly increase the plasma concentration of budesonide.
Analogs
The analogues of Pulmicort Turbuhaler are Alvesco, Beklazon EKO, Beclospir, Pulmicort, Flixotide, Fluticasone and others.
Terms and conditions of storage
Store at temperatures below 30 ° C out of reach of children.
Shelf life is 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Pulmicort Turbuhaler
Patients leave positive reviews about Pulmicort Turbuhaler, noting its high efficiency, fast action, good tolerance, ease of use, as well as an acceptable cost.
Price for Pulmicort Turbuhaler in pharmacies
The approximate price for Pulmicort Turbuhaler is: 455-510 rubles. for 100 doses of 200 mcg; RUB 828–876 for 200 doses of 100 mcg.
Pulmicort Turbuhaler: prices in online pharmacies
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Drug name Price Pharmacy |
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Pulmicort Turbuhaler 200 mcg / dose 100 doses powder for inhalation dosed 1 pc. 328 RUB Buy |
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Pulmicort Turbuhaler powder for in. dosage. 200mcg / dose 100 doses 395 RUB Buy |
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Pulmicort Turbuhaler 100 mcg / dose 200 doses powder for inhalation dosed 1 pc. 709 r Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
