Pulmicort Flexhaler : Uses, Side Effects, Interactions & More

Why is this medication prescribed?

Pulmicort Flexhaler (Budesonide) is used to prevent shortness of breath, chest tightness, wheezing, and coughing caused by asthma. Pulmicort Flexhaler powder for oral inhalation is used in adults and children 6 years of age and older. Pulmicort is in a class of medications called corticosteroids. It works by reducing swelling and irritation in the airways to make breathing easier.

How should this medicine be used?

Pulmicort Flexhaler (Budesonide) comes as a powder to be inhaled by mouth with an inhaler and as a suspension to be inhaled by mouth with a special jet nebulizer (a machine that turns the medicine into a mist that can be inhaled). Pulmicort Flexhaler powder for oral inhalation is usually inhaled twice a day. Pulmicort suspension for oral inhalation is usually inhaled once or twice a day. Try to use Pulmicort at around the same time every day. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any parts you do not understand. Use Pulmicort exactly as directed. Do not use more or less or use it more often than prescribed by your doctor.

Talk to your doctor about how you should use your other oral and inhaled asthma medications during your treatment with Pulmicort inhalation. If you were taking an oral steroid such as dexamethasone, methylprednisolone (Medrol), or prednisone (Rayos), your doctor may want to gradually decrease your steroid dose after you start using Pulmicort.

Pulmicort controls asthma symptoms but does not cure it. Your asthma may improve as soon after using the medicine, but the full effects may not be seen 1 to 2 weeks after using the powder and 4 to 6 weeks after using the suspension regularly. Keep using Pulmicort even if you feel fine. Do not stop using Pulmicort without consulting your doctor. Call your doctor if your / your child’s symptoms do not improve during the first 2 weeks (dust) or the first 6 weeks (suspension) or if they get worse.

Pulmicort Flexhaler helps prevent asthma attacks (sudden episodes of shortness of breath, wheezing, and coughing) but will not stop an asthma attack that has already started. Your doctor will prescribe a short-acting inhaler for you to use during asthma attacks. Tell your doctor if your asthma worsens during your treatment.

Each Pulmicort inhaler is designed to deliver 60 or 120 puffs, depending on its size. After the number of puffs indicated on the label have been used, subsequent puffs may not contain the correct amount of medicine. You should keep track of the number of puffs you have used. You can divide the number of puffs on your inhaler by the number of puffs you use each day to find out how many days your inhaler will last. Throw away the inhaler after you have used the number of puffs indicated on the label, even if it still contains some liquid and continues to deliver an aerosol when pressed.

Do not swallow the suspension from the Pulmicort nebulizer.

Before using your Pulmicort inhaler or jet nebulizer for the first time, read the written instructions that come with it. Look at the diagrams carefully and make sure you recognize all parts of the inhaler or nebulizer. Ask your doctor, pharmacist, or respiratory therapist to show you the correct way to use your inhaler or nebulizer. Practice using the inhaler or nebulizer in front of him or her, to be sure you are doing it the right way.

To inhale the powder using the inhaler, follow these steps:

  1. Rotate the protective cover and lift it up.
  2. The first time you use a new Pulmicort inhaler you must prime it. To do this, hold the inhaler upright (with the mouthpiece up), then turn the brown handle all the way to the right as much as possible and then turn it all the way to the left again. You will hear a click. Repeat. The unit is now primed and ready to load the first dose. You do not need to re-prime the inhaler after this, even if you do not use it for a long time.
  3. Holding the inhaler upright, load the first dose by turning the handle all the way to the right and all the way to the left until it clicks.
  4. Turn your head away from the inhaler and breathe out. Do not blow or exhale into the inhaler. Do not shake the inhaler after loading it.
  5. Hold the inhaler upright (mouthpiece up) or horizontal. Place the mouthpiece firmly between your lips in your mouth. Tilt your head slightly back. Close your lips tightly around the mouthpiece, but do not bite or chew the mouthpiece. Inhale deeply and vigorously. Make sure the mist gets into your throat and is not blocked by your teeth or tongue.
  6. Remove the inhaler from your mouth and hold your breath for about 10 seconds. Do not blow or exhale through the inhaler.
  7. If you are taking two puffs, repeat steps 4-6. For the next inhalation, the inhaler should be loaded in an upright position just before use. Rotate the grip all the way to the right and then all the way to the left until it clicks.
  8. Put the protective cap back on the inhaler and twist to close.
  9. After each treatment, rinse your mouth with water and spit. Do not swallow the water.
  10. Keep the inhaler clean and dry with the cover on tight at all times.
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To inhale the suspension using the jet nebulizer, follow these steps:

  1. Remove one ampoule of suspension for inhalation from the foil pouch.
  2. Gently shake the vial in circular motions.
  3. Hold the vial upright and twist the top of the vial. Pour all the liquid into the nebulizer reservoir. Do not mix other medicines with Pulmicort in the reservoir.
  4. Attach the nebulizer reservoir to the mouthpiece or mask.
  5. Connect the nebulizer to the compressor.
  6. Put the mouthpiece in your child’s mouth or wear the mask. Have your child sit upright and comfortable and turn on the compressor.
  7. Tell your child to breathe calmly, deeply, and evenly until the mist stops forming in the chamber.
  8. After each treatment, have your child rinse her mouth with water and spit; do not swallow the water.
  9. Dispose of the empty vial and its top in a trash can that is out of the reach of children and pets.
  10. Clean your nebulizer regularly. Follow the manufacturer’s instructions carefully and ask your doctor or pharmacist if you have any questions about cleaning your nebulizer.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using Pulmicort Flexhaler,

  • Tell your doctor and pharmacist if you are allergic to Pulmicort, any other medications, or any of the ingredients in Pulmicort inhalation powder or nebulizer solution. If you are using the powder for inhalation, also tell your doctor if you are allergic to milk proteins. Ask your pharmacist or see the Medication Guide for a list of the ingredients.
  • Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or have recently taken. Be sure to mention any of the following: antifungals such as itraconazole (Onmel, Sporanox) and ketoconazole (Nizoral); clarithromycin (Biaxin); HIV protease inhibitors such as atazanavir (Reyataz, in Evotaz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra, in Viekira Pak, others), and saquinavir (Invirase); seizure medications, nefazodone; oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); and telithromycin (Ketek). Your doctor may need to change the doses of your medications or monitor you closely for side effects. Many other medications can also interact with Pulmicort Flexhaler inhalation, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
  • Do not use Pulmicort Flexhaler during an asthma attack. Your doctor will prescribe a short-acting inhaler for you to use during asthma attacks. Call your doctor if you have an asthma attack that does not stop when you use quick-acting asthma medicine, or if you need to use more quick-acting medicine than usual.
  • Tell your doctor if you or anyone in your family has or has ever had osteoporosis (a condition in which the bones become thin and weak and break easily) and if you have or have ever had tuberculosis (TB; an infection lung disease) in your lungs, cataracts (clouding of the lens of the eye), glaucoma (an eye disease) or high eye pressure or liver disease. Also tell your doctor if you have any type of untreated infection anywhere in your body or a herpes eye infection (a type of infection that causes a sore on the eyelid or on the surface of the eye).
  • Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using Pulmicort, call your doctor.
  • If you are having surgery, including dental surgery, tell the doctor or dentist that you are using Pulmicort.
  • If you have other medical conditions, such as asthma, arthritis, or eczema (a skin disease), they can get worse when the dose of oral steroids is reduced. Tell your doctor if this happens or if you experience any of the following symptoms during this time: extreme tiredness, muscle weakness, or pain; sudden pain in the stomach, lower body, or legs; loss of appetite; weightloss; stomachache; vomiting diarrhea; dizziness; Fainting; depression; irritability; and darkening of the skin. Your body may be less able to cope with stress, such as surgery, illness, severe asthma attack, or injury during this time. Call your doctor right away if you get sick and make sure all healthcare providers who treat you know that you recently replaced your oral steroid with Pulmicort Flexhaler inhalation. Carry a medical identification card or bracelet with you to inform emergency personnel that you may need to receive steroid treatment in an emergency.
  • Tell your doctor if you have never had chickenpox or measles and have not been vaccinated against these infections. Stay away from sick people, especially those with chickenpox or measles. If you are exposed to one of these infections or if you have symptoms of one of these infections, call your doctor immediately. You may need treatment to protect yourself from these infections.
  • You should know that inhaling Pulmicort Flexhaler sometimes causes wheezing and shortness of breath immediately after inhaling it. If this happens, use your fast-acting (rescue) asthma medicine right away and call your doctor. Do not reuse Pulmicort inhalation unless your doctor tells you to.
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What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

What side effects can this medication cause?

Pulmicort Flexhaler inhalation may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • headache
  • stuffy or runny nose
  • sore throat
  • diarrhea
  • loss of appetite
  • stomach pain
  • difficulty falling asleep or staying asleep
  • neck or back pain
  • ear infections
  • nosebleeds

Some side effects can be serious. If you experience any of the following symptoms or those in the SPECIAL PRECAUTIONS section, call your doctor immediately or get emergency medical treatment:

  • white spots or sores in your mouth
  • rash
  • hives
  • itching
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness
  • difficulty breathing or swallowing
  • wheezing
  • cough
  • chest pain
  • anxiety
  • fever, chills, or other signs of infection
  • tiredness
  • nausea
  • vomiting
  • weakness
  • changes in vision

Inhaling Pulmicort Flexhaler can make children grow more slowly. There is not enough information to know if the use of Pulmicort decreases the final height that children will reach when they stop growing. Your child’s doctor will carefully watch your child’s growth while using Pulmicort. Talk to your child’s doctor about the risks of giving this medicine to your child.

In rare cases, people who used Pulmicort Flexhaler for a long time developed glaucoma or cataracts. Talk to your doctor about the risks of using Pulmicort and how often you should have your eyes examined during your treatment.

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Pulmicort Flexhaler can increase your risk of developing osteoporosis (a condition in which bones become thin and weak and break easily). Talk to your doctor about the risks of using this medicine.

Inhaling Pulmicort may cause other side effects. Call your doctor if you have any unusual problems while using this medicine.

If you experience a serious side effect, you or your doctor can submit a report online to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medicine in the container it came in, tightly closed, and out of the reach of children. Keep the nebulizer vials sealed in their foil pouches until you are ready to use them. Store the inhaler and nebulizer solution at room temperature and away from excess heat and moisture (not in the bathroom). Do not refrigerate or freeze the nebulizer solution. If you are using the inhalation powder, replace your old inhaler each time you refill your prescription. If you are using the nebulizer solution, you must discard the vials if you do not use them 2 weeks after opening the foil pouch.

It is important to keep all medicines out of the sight and reach of children, as many containers (such as those containing weekly pills and those for eye drops, creams, patches, and inhalers) are not child-resistant and small children can easily open them. To protect young children from poisoning, always close the safety caps and immediately place the medicine in a safe place, one that is upright and out of their sight and reach. http://www.upandaway.org

Unnecessary medications must be disposed of in special ways to ensure that pets, children, and others cannot consume them. However, you should not flush this medicine down the toilet. Instead, the best way to dispose of your medications is through a drug take-back program. Talk to your pharmacist or contact your local garbage / recycling department to find out about take-back programs in your community. Check out the FDA drug safe disposal website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What other information should I know?

Keep all appointments with your doctor and the laboratory.

Don’t let anyone use your medicine. Ask your pharmacist any questions you have about refilling your prescription.

It is important that you keep a written list of all prescription and over-the-counter (over-the-counter) medications you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should take this list with you each time you visit a doctor or if you go into hospital. It is also important information to take with you in case of emergencies.

Brand Names

  • Pulmicort®
  • Pulmicort® Flexhaler
  • Pulmicort® Respules

Disclaimer: DrLinex has made every effort to ensure that all information is factually accurate, comprehensive and up-to-date. However, this article should not be used as a licensed health care professional’s choice of knowledge and expertise. You should always consult your doctor or other health care professional before taking any medication. The information given here is subject to change and it has not been used to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions or adverse effects. The lack of warning or other information for any drug does not indicate that the combination of medicine or medication is safe, effective or appropriate for all patients or all specific uses. 


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