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Pulmicort Turbuhaler

Pronounced: PULL-mi-cort
Generic name: Budesonide

Why is this drug prescribed: Budesonide, the active ingredient in Pulmicort Turbuhaler, is an anti-inflammatory steroid medication. Inhaled on a regular basis, Pulmicort helps prevent asthma attacks. It is sometimes prescribed in addition to oral steroids, and may reduce or eliminate the need for them. Pulmicort Turbuhaler is used to treat asthma in adults and children over age 6. Children 12 months to 8 years of age can be treated with another form of budesonide, Pulmicort Respules, which is given by nebulizer. Both types of Pulmicort are preventive medicines. They will not relieve an acute or life-threatening episode of asthma.

Most important fact about this drug: Because steroids can suppress the immune system, people taking Pulmicort may become more susceptible to infections, and their infections could be more severe. If you are taking Pulmicort, avoid exposure to infectious diseases such as chickenpox and measles. If you are exposed, contact your doctor immediately.

How should you take this medication: Use Pulmicort Turbuhaler exactly as directed. The effectiveness of this medication depends on its regular use. Your doctor will prescribe the lowest effective dose. Do not take more or less medication than the amount prescribed. When starting therapy, carefully read the instructions that come with the inhaler. Your asthma symptoms may begin to improve in 24 hours, although you may not see the maximum benefit for 1 to 2 weeks or longer. If your symptoms do not improve or get worse, contact your doctor. Pulmicort Turbuhaler delivers a dose of medication in dry powder form. To assure the correct dose, the inhaler must be held in an upright position, with the mouthpiece on top, during priming and loading. Before its first use, each new inhaler must be primed. To prime the inhaler, hold it upright and turn the brown grip fully to the right, then fully to the left until it clicks. Repeat this procedure a second time. The unit is now primed. The inhaler must be loaded with medication immediately prior to each use. As you did when priming the unit, turn the brown grip fully to the right, then fully to the left until it clicks. During inhalation, the inhaler must be held in an upright (mouthpiece up) or horizontal position. Do not shake the inhaler. Place the mouthpiece between your lips and inhale forcefully and deeply. The Pulmicort powder is then delivered to the lungs. Do not exhale through the inhaler. You may not taste or sense any medication entering the lungs when inhaling from the Turbuhaler. This lack of sensation is not a cause for concern, and does not mean that you'll fail to receive the medication's benefits. To decrease the risk of developing a fungus infection in the mouth, rinse it with water, without swallowing, after each dose. Do not use the inhaler with a spacer. Do not bite or chew the mouthpiece. --If you miss a dose... Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once. --Storage instructions... Keep the Pulmicort Turbuhaler clean at all times. Replace the cover securely after each opening. Store with the cover tightened in a dry place at room temperature. Discard the unit when a red mark appears in the indicator window.

What side effects may occur: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Pulmicort. More common side effects may include: Aching joints, back pain, cough, fever, flu-like symptoms, fungal infection in mouth, headache, indigestion, nasal and sinus inflammation, pain, respiratory infection, sore throat, weakness Less common side effects may include: Abdominal pain, abnormal taste, bleeding under the skin, dry mouth, fainting, fracture, infection, insomnia, migraine, muscle contractions, muscle pain, nausea, neck pain, stomach or intestinal inflammation, voice alteration, vomiting, weight gain Rare side effects may include: Abnormal thinking, aggressiveness, anxiety, depression, difficulty breathing, hives, irritability, rash or dermatitis

Why should this drug not be prescribed: If you are allergic to budesonide, you cannot use Pulmicort.

Special warnings about this medication: If you are switching to Pulmicort from an oral steroid medication, the doctor will be careful to reduce your oral dosage very gradually. Taking oral steroids suppresses the natural production of steroids by the adrenal gland, and it takes months for production to return to normal after the oral steroids are stopped. In the meantime, the body will be unusually vulnerable to stress. There have been reports of death during and immediately after transfer from oral steroids to inhaled steroids, so your doctor will monitor you carefully during this period. People who have been taking high doses of oral steroids for an extended period of time are especially prone to problems, particularly when the oral steroids have been almost completely stopped. At that point, any stress from trauma, surgery, or infection (especially stomach or intestinal inflammation) is more likely to trigger adverse events. If you experience a period of stress or a severe asthma attack during your switch to Pulmicort, you should begin taking your oral medication again (in large doses) and contact your doctor immediately. You should carry a medical identification card indicating that you may need additional medication during periods of stress or a severe asthma attack. Transfer from oral steroids to Pulmicort may unmask allergic conditions previously controlled by those steroids, such as nasal inflammation, conjunctivitis (pinkeye), and eczema. Transfer from oral steroids may also be accompanied by withdrawal symptoms, including joint or muscle pain, fatigue, and depression, even while Pulmicort is improving your asthma symptoms. Like other inhaled asthma medications, Pulmicort occasionally triggers an asthma attack. If this occurs, immediately use a fast-acting inhaled bronchodilator, stop using Pulmicort, and contact your doctor. You'll need to switch to a different asthma medication. Also alert your doctor immediately if the usual doses of your fast-acting bronchodilator no longer work. You may need to take oral steroids for a while. Steroid medications can stunt growth in children and teenagers. Your doctor will prescribe the lowest effective dose of Pulmicort in order to minimize this problem, and will monitor the child's growth carefully. While using this medication, some people develop fungal infections in the mouth and throat. If this occurs, the doctor can prescribe antifungal medication while you continue to use Pulmicort. People with tuberculosis, ocular herpes simplex, or any untreated fungal, bacterial, viral, or parasitic infection should use inhaled steroids with caution. Caution is also in order if you have liver disease. In rare instances, inhaled steroids have been known to cause glaucoma (increased pressure in the eye) and cataracts.

Possible food and drug interactions when taking this medication: If Pulmicort is taken with certain other drugs, the effects of either can be increased, decreased, or altered. It is especially important to check with your doctor before combining Pulmicort with ketoconazole (Nizoral).

Special information if you are pregnant or breastfeeding: Pulmicort does not appear to harm the developing infant during pregnancy. Nevertheless, the possibility for harm cannot be ruled out. This medication should be used during pregnancy only if it is clearly needed. Steroids make their way into breast milk. Because they could affect the nursing infant, you'll need to either discontinue breastfeeding or stop taking this medication.

Recommended dosage: ADULTS: The usual dosage depends on your previous treatments for asthma. If you have previously been using only fast-acting bronchodilators, the usual starting dose is 200 to 400 milligrams twice a day. The maximum long-term dosage is 400 milligrams twice daily. If you have previously been using inhaled steroids, the usual starting dose is 200 to 400 milligrams twice a day (or once daily in the morning or evening if your asthma has been well controlled). The maximum long-term dosage is 800 milligrams twice daily. If you have previously been taking oral steroids, the usual starting dose is 400 to 800 milligrams twice a day. The maximum long-term dosage is 800 milligrams twice daily. If you are taking oral steroids, you will continue to do so while starting Pulmicort Turbuhaler. After one week, the doctor will lower your dose of oral steroids, then gradually lower it further at one- or two-week intervals. CHILDREN AGE 6 AND OLDER: As with adults, the child's usual dosage depends on previous treatments. If the child has previously been using only a fast-acting bronchodilator the usual starting dose is 200 milligrams twice a day. The maximum long-term dosage is 400 milligrams twice daily. If the child has previously been using inhaled steroids, the usual starting dose is 200 milligrams twice daily. (A once-a-day dose of 200 or 400 milligrams may be prescribed instead.) The maximum long-term dosage is 400 milligrams twice daily. If the child has previously been taking oral steroids, the highest recommended dose is 400 milligrams taken twice a day. As with adults, the dosage of oral steroids will be gradually reduced while the child continues to take Pulmicort.

Overdosage: Excessive doses of steroid medications taken for long periods can stunt growth or cause a condition called Cushing's syndrome. Symptoms of this condition include weight gain, a "moon face," muscle wasting, weakness, and poor wound healing. If you think a problem is developing, check with your doctor immediately.

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