What are the requirements to order budesonide to a pharmacy?

How to Order Budesonide to a Pharmacy

Budesonide inhalation suspension requires no special ordering requirements beyond a standard prescription—simply write for the appropriate formulation (0.25 mg/2 mL or 0.5 mg/2 mL single-dose ampules), specify the dose and frequency, and send to any pharmacy that stocks nebulizer medications. 1

Prescription Writing Essentials

When ordering budesonide inhalation suspension to a pharmacy, include the following elements on your prescription:

• Drug name and formulation: Specify "Budesonide Inhalation Suspension" (not for injection, not for ultrasonic nebulizers) 1
• Strength: Available as 0.25 mg/2 mL or 0.5 mg/2 mL single-dose ampules 1
• Dose and frequency: Based on patient age and previous therapy (see dosing algorithm below) 1
• Quantity: Typically dispensed in boxes of 30 ampules
• Directions: "For oral inhalation via jet nebulizer only" 1

Age-Based Dosing Algorithm

For children 12 months to 8 years of age (FDA-approved indication) 1:

• If previously on bronchodilators alone: Start 0.5 mg once daily OR 0.25 mg twice daily 1
• If previously on inhaled corticosteroids: Start 0.5 mg once daily OR 0.25 mg twice daily, up to 0.5 mg twice daily 1
• If previously on oral corticosteroids: Start 0.5 mg twice daily 1
• If symptomatic on non-steroidal therapy: May consider 0.25 mg once daily as starting dose 1

For children 0-4 years (per specialty guidelines):

• Low-dose therapy: 0.25-0.5 mg twice daily 2
• Medium-dose therapy: >0.5-1.0 mg twice daily 2

Administration Instructions to Include

Provide these specific directions for the pharmacy to include on the label 2, 3:

• Use with compressed air-driven jet nebulizer only (not ultrasonic devices) 1
• For children <4 years, use face mask that fits snugly over nose and mouth 2
• Avoid nebulizing in the eyes 2
• Wash face after each treatment to prevent oral candidiasis 2, 3
• May mix with albuterol, ipratropium, or levalbuterol nebulizer solutions in same nebulizer 2

Common Prescribing Pitfalls to Avoid

Do not prescribe budesonide inhalation suspension for:

• Acute bronchospasm or status asthmaticus (this is a maintenance medication only) 1
• Use with ultrasonic nebulizers (only jet nebulizers are appropriate) 1
• Patients with known hypersensitivity to budesonide 1

Critical safety considerations to document:

• If transferring from oral corticosteroids, taper the systemic steroid slowly while monitoring for adrenal insufficiency 1
• Monitor growth in pediatric patients receiving long-term therapy 1
• Caution with concurrent strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) due to increased systemic exposure 1

No Special Pharmacy Requirements

Unlike controlled substances or specialty medications, budesonide inhalation suspension:

• Requires no prior authorization in most cases (though insurance may vary)
• Is not a controlled substance
• Can be dispensed by any retail or mail-order pharmacy
• Does not require specialty pharmacy distribution
• Has no REMS (Risk Evaluation and Mitigation Strategy) program

The pharmacy will typically stock this as a refrigerated item and should counsel patients on proper nebulizer technique and storage.