Generic Pulmicort (Budesonide)

What is generic Pulmicort?

Generic Pulmicort is any inhaled medicine that contains budesonide on its own, the inhaled corticosteroid in Pulmicort Flexhaler (a dry-powder inhaler) and Pulmicort Respules (a suspension for nebulizers). It calms airway swelling, so over time asthma symptoms and attacks become less frequent. Cipla's Budecort range from India contains the same active ingredient and is made and licensed in India.

In the US, FDA-approved generic budesonide inhalation suspension (the nebulizer form) is made by more than one company; one example is this generic budesonide suspension label on DailyMed.

Is Budecort the same as Pulmicort?

Both are budesonide-only asthma preventers, but they differ in maker, devices and approval.

Which Budecort strength matches Pulmicort?

Pulmicort Flexhaler is named by its metered dose, but the US label says the 90 mcg device delivers 80 mcg and the 180 mcg device delivers 160 mcg from the mouthpiece (Pulmicort Flexhaler label on DailyMed). Aerosol and capsule devices deliver differently again, so Budecort doses cannot be swapped microgram for microgram with the Flexhaler; your doctor should set the strength and puffs.

Respules are easier to compare: Budecort 0.5 mg and 1 mg ampules hold the same labeled amount as the matching Pulmicort Respules strengths.

Which budesonide products are available here?

How do I choose between the inhaler, Rotacaps and Respules?

• Aerosol inhaler: small and quick to use, but pressing and breathing in must be timed together; a spacer makes this easier, especially for children.
• Rotacaps: breath-activated capsules that you load into a compatible capsule inhaler device. You need a fast, deep breath to draw the powder in. Never swallow the capsules.
• Respules: a liquid breathed in through a nebulizer with a mouthpiece or face mask, useful for young children who cannot manage an inhaler. The US label covers children aged 12 months to 8 years.

Budecort contains budesonide alone. If your doctor wants budesonide combined with the long-acting bronchodilator formoterol, see our Foracort vs Symbicort comparison. See also our guide to the types of asthma inhalers.

Is budesonide a preventer or a reliever?

Budesonide is a preventer. It will not stop symptoms that have already started (MedlinePlus on budesonide inhalation). Keep a fast-acting reliever such as albuterol (salbutamol), for example Asthalin Inhaler, with you for sudden wheeze or breathlessness.

Use budesonide every day, even when you feel well. With the Flexhaler, improvement can begin within 24 hours, but full benefit may take 1 to 2 weeks or longer. With Respules, improvement may start within 2 to 8 days, and full benefit can take 4 to 6 weeks.

How do you use budesonide inhalers and respules?

Your doctor decides the dose. For reference, the US Flexhaler label starts adults at 360 mcg twice daily (180 mcg twice daily may be enough for some), up to 720 mcg twice daily, and children aged 6 to 17 at 180 mcg twice daily, up to 360 mcg twice daily. For Pulmicort Respules, the total daily dose for children aged 12 months to 8 years ranges from 0.25 mg to 1 mg, given once a day or split into two doses, and never more than 1 mg a day (Pulmicort Respules label on DailyMed). Some children have a lower ceiling depending on their earlier treatment.

• Inhaler: shake it, breathe out away from the mouthpiece, then press once as you start a slow, deep breath and hold your breath for as long as is comfortable.
• Rotacaps: load one capsule as the device leaflet shows, breathe out away from the device, then breathe in quickly and deeply through the mouthpiece.
• Respules: use a jet nebulizer connected to an air compressor, not an ultrasonic nebulizer. Gently shake the ampule in a circular motion, and do not mix it with other nebulized medicines. Use an opened ampule straight away, and keep unopened ones in their foil pack. If your child uses a face mask, wash their face afterward.
• After every dose: rinse your mouth with water and spit it out. This lowers the risk of oral thrush.

What are the side effects of budesonide?

In US trials, the more common side effects of the Flexhaler included cold-like symptoms, a stuffy nose, sore throat, nausea and oral thrush. The problems most often reported in children using Respules were respiratory infections, a runny nose, cough and ear infections.

Get medical help quickly for wheezing that worsens right after a dose, rash, hives, swelling of the face or throat, white patches in the mouth that do not clear, or changes in vision. Long-term or high-dose use can slow growth in children, raise the risk of glaucoma, cataracts and bone thinning, and reduce the body's own steroid production.

Who should not use budesonide?

• Anyone allergic to budesonide or any ingredient. The Flexhaler must not be used by people with a severe milk-protein allergy; dry-powder capsules may also contain lactose, so check the Budecort leaflet.
• It must not be used as the main treatment for a severe asthma attack.
• Tell your doctor about tuberculosis or other untreated infections, glaucoma, cataracts or osteoporosis, and about any exposure to chickenpox or measles if you have not had them.
• If you are switching from steroid tablets such as prednisone, your doctor should reduce the tablets slowly.
• Strong CYP3A4 inhibitors, such as ketoconazole, itraconazole, clarithromycin and ritonavir, can raise budesonide levels in the body, so tell your doctor about every medicine you take.

For other asthma medicines, visit our asthma category.

Frequently asked questions

Is there a generic version of Pulmicort in the US?

Yes, FDA-approved generic budesonide inhalation suspension is available in the US. Budecort is a separate Indian brand with the same active ingredient.

Can adults use Budecort Respules?

The US label for budesonide respules covers children aged 12 months to 8 years. Use in older children and adults is outside that label, so it should happen only if your own doctor prescribes it.

Do I need to rinse my mouth after using budesonide?

Yes. Rinse with water and spit it out after each dose, whichever device you use. This lowers the risk of thrush in the mouth and throat.

Can I stop budesonide once my asthma feels better?

No. Feeling better usually means the preventer is working. Talk to your doctor before lowering or stopping the dose.

How long does delivery take?

Product pages state delivery in about 6 to 15 days to the USA, and customs checks can add delays.

This article gives general information and does not replace advice from your doctor or pharmacist. Budesonide is a prescription medicine and should be used only as prescribed for your own condition. During an asthma attack, use your reliever and seek emergency care if it does not help.