From the Guidelines
Pulmicort (budesonide) and Fluticasone are not directly interchangeable on a mcg or per-puff basis, and the most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy. When considering the potency of these medications, it's essential to note that Fluticasone is approximately twice as potent as Pulmicort (budesonide) 1. This means that the dose of Fluticasone required to achieve similar clinical effects as Pulmicort would be lower. Some key points to consider when using these medications include:
- The dose of Fluticasone should be divided 2 times daily, and for children <4 years of age, the low dose is higher than for children 5-11 years of age due to the lower dose delivered with a face mask 1.
- Budesonide suspension is compatible with albuterol, ipratropium, and levalbuterol nebulizer solutions in the same nebulizer, and only jet nebulizers should be used because ultrasonic nebulizers are ineffective for suspensions 1.
- Corticosteroid side effects can be minimized by washing the face after each treatment to prevent local side effects 1.
- The safety and efficacy of ICSs in children <1 year have not been established, and for children <4 years of age, the dose should be carefully titrated to the minimum dose required to maintain control 1. In terms of equivalent dosing, a general guideline is that 200 mcg of Pulmicort would be roughly equivalent to 100 mcg of Fluticasone, but this can vary depending on individual patient responses and should be monitored closely by a clinician.
From the Research
Pulmicort Fluticasone Equivalent
The equivalent dose of Pulmicort (budesonide) to fluticasone propionate can vary depending on the study and the specific context.
- A study published in 2007 2 found that the potency difference between fluticasone propionate (Flixotide Diskus) and budesonide (Pulmicort Turbuhaler) was between 1.50:1 and 1.75:1, depending on the dose and patient population.
- Another study from 2001 3 compared the pharmacokinetic and pharmacodynamic properties of fluticasone propionate and budesonide in healthy subjects, and found that fluticasone propionate had slower pulmonary absorption and slower elimination kinetics than budesonide.
- A 2011 review 4 compared the effects of fluticasone/salmeterol and budesonide/formoterol in patients with asthma, and found that the two treatments had similar effects on lung function and symptoms, but that fluticasone/salmeterol may have a slightly higher risk of serious adverse events.
- A study from 1999 5 compared the effects of high-dose fluticasone propionate and budesonide on lung function and asthma exacerbations in patients with severe asthma, and found that fluticasone propionate was statistically significantly superior to budesonide with respect to several outcomes, including symptom-free days and peak expiratory flow.
- A 2002 review 6 compared the efficacy and safety of fluticasone propionate to beclomethasone or budesonide in the treatment of chronic asthma, and found that fluticasone propionate produced a significantly greater improvement in forced expiratory volume (FEV1) and peak expiratory flow (PEF) than beclomethasone or budesonide at a dose ratio of 1:2.
Key Findings
- The equivalent dose of Pulmicort (budesonide) to fluticasone propionate can vary depending on the study and context.
- Fluticasone propionate may have a slightly higher potency than budesonide, with a potency ratio of 1.50:1 to 1.75:1.
- The two treatments have similar effects on lung function and symptoms, but fluticasone/salmeterol may have a slightly higher risk of serious adverse events.
- Fluticasone propionate may be more effective than budesonide in patients with severe asthma, with improvements in symptom-free days and peak expiratory flow.
- Fluticasone propionate produces a significantly greater improvement in FEV1 and PEF than beclomethasone or budesonide at a dose ratio of 1:2.