Can Pulmicort Nebulizer Cause Shaking?
Pulmicort (budesonide) nebulizer itself does NOT typically cause shaking or tremors, as it is an inhaled corticosteroid without direct beta-agonist effects. However, tremor can occur if Pulmicort is contaminated with or mixed with beta-agonist bronchodilators like albuterol (salbutamol) or terbutaline, which are commonly nebulized alongside steroids and are well-known to cause tremor as a side effect.
Understanding the Mechanism
Budesonide's Side Effect Profile
- Budesonide is a corticosteroid that works through anti-inflammatory mechanisms in the airways 1, 2
- Long-term studies of budesonide in over 1,100 patients showed the most common adverse events were respiratory infection, sinusitis, and pharyngitis—not tremor 1
- Multiple clinical trials evaluating budesonide safety in adults and children did not identify tremor as a characteristic side effect of the medication 2, 3
Beta-Agonists Cause Tremor
- Beta-agonists such as salbutamol and terbutaline are especially likely to cause tremor, particularly in elderly patients, and high doses should be avoided unless necessary 4
- In a comparative study, tremor occurred in 12% of patients receiving high-dose budesonide/formoterol (which contains a beta-agonist) versus 17% with terbutaline alone 5
- Bronchodilators like beta-agonists and ipratropium bromide are frequently mixed together in nebulizers with steroids 4
Clinical Considerations
Common Nebulizer Practices
- Nebulized budesonide (Pulmicort Respules) is often administered in the same treatment session as bronchodilators 4
- The volume of fluid in nebulizer chambers is usually 2.0-4.5 ml, and bronchodilators are sometimes mixed together to make up this volume 4
- If you are experiencing tremor, verify whether your nebulizer treatment contains only budesonide or if it has been mixed with a beta-agonist bronchodilator 4
Important Pitfalls to Avoid
- Patients should rinse their mouth after nebulizing steroids to prevent oral thrush, not tremor 6, 7
- Mouthpieces should be used for nebulized steroids to prevent facial deposition 6, 7
- Regular preventative treatment should continue even when using a nebulizer 8
What to Do If Experiencing Tremor
- Contact your prescribing physician to clarify exactly what medications are in your nebulizer solution 4, 8
- If a beta-agonist is included and causing problematic tremor, discuss dose reduction or alternative delivery methods with your doctor 4
- In elderly patients with ischemic heart disease, high-dose beta-agonist treatment should be used with particular caution, as tremor is more common in this population 4