An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (., myasthenia gravis ), or in patients receiving concomitant therapy with neuromuscular blocking drugs (., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis . Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.
mg/day inhaled via jet nebulizer either once daily or divided into 2 doses. The maximum manufacturer recommended total dose is 1 mg/day. The National Asthma Education and Prevention Program Expert Panel defines low dose therapy for budesonide inhalation suspension as mg/day, medium dose therapy as 1 mg/day, and high dose therapy as 2 mg/day for children ages 5 to 11 years. Titrate to the lowest effective dose once asthma stability is achieved. Prolonged use of high doses, ., 2 mg/day, may be associated with additional adverse effects.
A slightly increased number of basophilic hepatic foci were observed in chronic rat studies with budesonide, and in carcinogenicity studies there was an increased incidence of primary hepatocellular neoplasms, astrocytomas (in male rats) and mammary tumours (female rats) observed. These tumours are probably due to the specific steroid receptor action, increased metabolic burden on the liver and anabolic effects, effects which are also known from other glucocorticosteroids in rat studies and therefore represent a class effect. No similar effects have ever been observed in man for budesonide, neither in clinical trials nor from spontaneous reports.