Budesonide (Rhinocort) Nasal Spray Dosage for Allergic Rhinitis
For adults with allergic rhinitis, budesonide (Rhinocort) nasal spray should be administered as 2 sprays per nostril twice daily (total 128 μg per day) or 4 sprays per nostril in the morning (total 128 μg per day). 1
Dosage Recommendations by Age Group
Adults (≥12 years):
- Standard dosage: 2 sprays per nostril twice daily OR 4 sprays per nostril once daily in the morning
- Each spray contains 32 μg of budesonide
- Total daily dose: 128 μg
Children (6-11 years):
- Standard dosage: 2 sprays per nostril twice daily
- Total daily dose: 128 μg
- Approved for use in children ≥6 years 1
Children (<6 years):
- Not FDA approved for children under 6 years of age 1
Indications and Formulation
- Indications: Allergic rhinitis and nonallergic rhinitis
- Formulation: Aqueous solution (32 μg per spray)
- Contraindications: History of hypersensitivity to medication or components 1
Administration Technique
For optimal delivery and efficacy:
- Insert tip gently into the nostril
- Direct spray away from the nasal septum to prevent irritation
- Keep head upright during administration
- Use right hand to spray left nostril and vice versa
- Breathe in slowly while spraying 2
Common Side Effects
- Epistaxis (nosebleed)
- Pharyngitis (sore throat)
- Bronchospasm
- Coughing
- Nasal irritation 1
Efficacy and Onset of Action
Budesonide aqueous nasal spray demonstrates:
- Effective control of nasal symptoms in both seasonal and perennial allergic rhinitis
- Onset of action within 12 hours for combined nasal symptoms 3
- Significant reduction in nasal inflammation with decreased eosinophils and basophils 4
Safety Considerations
- No significant effect on hypothalamic-pituitary-adrenal (HPA) axis function when used as directed 5
- Examine nasal septum periodically for mucosal erosions
- Regular use provides better symptom control than intermittent use 2
Comparison with Other Formulations
Budesonide aqueous nasal spray at 256 μg once daily provides similar efficacy to budesonide pressurized metered dose inhaler at 400 μg/day (200 μg twice daily) 6, but the standard recommended dose is 128 μg/day as per FDA approval 1.
Clinical Pearls
- Budesonide has a high ratio of topical to systemic activity compared to other corticosteroids
- Undergoes extensive first-pass metabolism, resulting in minimal systemic activity 7
- Regular, consistent use provides better symptom control than as-needed use
- Allow at least 1-2 weeks of regular use to achieve maximum benefit