What are the side effects of budesonide (corticosteroid) in nasal rinse?

Side Effects of Budesonide in Nasal Rinse

The most common side effects of budesonide in nasal rinse are local irritation, nasal bleeding, and burning or stinging sensations, though these are typically mild and well-tolerated compared to systemic corticosteroid administration. 1

Local Side Effects

Nasal Irritation

• Burning or stinging sensations (more common with propylene glycol-containing solutions)
• Nasal dryness
• Blood-tinged secretions or epistaxis (more frequent than with placebo) 1
• Nasal septal irritation (rarely progressing to perforation with long-term use) 1

Prevention of Local Side Effects

• Direct the irrigation away from the nasal septum to prevent repetitive direct application 1
• Periodic examination of the nasal septum is recommended to detect early mucosal erosions 1

Systemic Side Effects

Hypothalamic-Pituitary-Adrenal (HPA) Axis Effects

• Generally minimal at recommended doses
• Asymptomatic HPA axis suppression may occur in approximately 23% of patients with long-term use (>6 months) 2
• Risk factors for HPA suppression include concomitant use of both nasal steroid sprays and pulmonary steroid inhalers 2

Ocular Effects

• No increased risk of glaucoma with standard doses 1
• No evidence of posterior subcapsular cataract development in studies up to 24 weeks 1
• Intraocular pressure typically remains within normal limits even with long-term use 2

Bone Effects

• Short-term administration of budesonide at 200 mcg/day showed no suppression of plasma osteocalcin levels 1
• Limited data on long-term effects on bone mineral density specifically with nasal irrigation

Growth Effects in Children

• Studies with intranasal budesonide show no effects on growth at recommended doses compared to placebo 1
• Growth suppression is more likely with higher doses or in very young children 1

Safety Profile of Budesonide Nasal Irrigation

• Multiple studies have demonstrated that budesonide nasal irrigations are generally well-tolerated 1, 3
• No evidence of histopathological changes in the nasal mucosa even after 5.5 years of continuous treatment 4
• Nasal biopsies in patients with perennial allergic rhinitis show no evidence of atrophy or tissue damage after 1-5 years of therapy 1

Special Considerations

Risk Factors for Adverse Effects

• Concomitant use of multiple steroid formulations (nasal sprays, pulmonary inhalers, and irrigations) 2
• Long-term use exceeding 6 months 2
• Direct application to the nasal septum 1

Monitoring Recommendations

• Periodic examination of the nasal septum during long-term use 1
• Consider monitoring for HPA axis suppression in patients receiving long-term budesonide irrigation therapy, especially those using multiple steroid formulations 2
• No routine monitoring of intraocular pressure is necessary based on current evidence 1, 2

Practical Considerations

• Rinse mouth with water and spit after each treatment to reduce risk of oral candidiasis 5
• Budesonide nasal irrigation appears to be a viable treatment option with favorable efficacy and safety profile 3
• Improvement in symptoms can be expected within days to weeks of starting treatment 5

Despite the potential for side effects, budesonide nasal irrigations are generally safe and well-tolerated when used as directed, with a significantly better safety profile than systemic corticosteroids.