Budesal Respules
✅ Effective asthma management
✅ Convenient respule format
✅ Easy inhalation method
✅ Enhanced respiratory comfort
Contains Budesonide and Levalbuterol Sulphate
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Budesal Respules?
Budesal Respules contain budesonide 0.5/1 mg + levosalbutamol 1.25 mg in 2.5 ml, an unusual combination preservative-free nebuliser solution. The product delivers budesonide (an inhaled corticosteroid that reduces airway inflammation over 1–2 weeks of consistent dosing) plus levosalbutamol (a short-acting β2 agonist that begins bronchodilation in 1–5 minutes and lasts 4–6 hours). Used for moderate-to-severe acute asthma exacerbations and in patients who benefit from same-time anti-inflammatory + reliever delivery via nebulisation. Manufactured by Cipla.
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What Is Budesal Respules?
Budesal Respules combine an inhaled corticosteroid (budesonide) with a short-acting β2 agonist (levosalbutamol) in a single nebuliser respule. This unusual ICS-SABA combination is mainly an Indian-market formulation by Cipla. Most international ICS-LABA nebules use formoterol (long-acting) rather than levosalbutamol (short-acting).
How Does Budesal Respules Work?
- Budesonide binds glucocorticoid receptors, suppresses inflammatory cytokines, reduces eosinophil and lymphocyte recruitment, and stabilises airway mucosa. Effect builds over 1–2 weeks of consistent dosing.
- Levosalbutamol activates β2-adrenergic receptors, raising cyclic AMP and producing rapid bronchodilation. Onset 1–5 minutes; duration 4–6 hours. The R-isomer offers similar bronchodilation to racemic salbutamol with potentially less tremor and tachycardia.
- Combined: simultaneous symptom relief and anti-inflammatory dosing in one nebulisation — useful when a patient needs both, especially in moderate-to-severe acute attacks.
Uses and Indications
- Moderate-to-severe acute asthma exacerbations — combination ICS + reliever nebulisation
- Acute COPD exacerbations with significant inflammatory component
- Bronchospasm in young children and elderly who cannot use inhalers
- Step-down from hospital nebulisation to home use
Budesal Dosage
| Patient | Dose | Frequency |
|---|---|---|
| Adults — moderate exacerbation | 1 respule (1 mg / 1.25 mg) | Twice daily |
| Adults — acute severe (hospital) | 1 respule | Up to 4× daily under supervision |
| Children 6–12 yr | 0.5 mg / 1.25 mg respule | Twice daily |
| Children <6 yr | Specialist supervision | Reduced dose |
How to Use Budesal Respules
- Wash hands; assemble a clean dry nebuliser machine, cup, and mask or mouthpiece.
- Twist off the respule top; squeeze contents into the cup. Do not dilute.
- Switch on the compressor — fine mist appears within seconds.
- Breathe normally with occasional deep breaths; ensure tight mask seal in children.
- Continue 5–10 minutes until the cup sputters.
- Rinse mouth, gargle, and spit out; wipe child’s face after a mask session.
- Discard any unused respule (preservative-free); rinse cup and mouthpiece, air-dry.
Side Effects
- Mild tremor and palpitations (β2 effect from levosalbutamol)
- Oral thrush, hoarseness (ICS effect — minimised by rinsing)
- Throat irritation, cough on inhalation
- Headache
- Dry mouth
- Hypokalaemia at high doses (with diuretics, theophylline, oral steroids)
Serious — stop and seek help:
- Severe allergic reaction
- Paradoxical bronchospasm
- Severe palpitations or arrhythmia
Warnings and Precautions
- Modern guidelines increasingly favour ICS-formoterol SMART/MART (long-acting β2) over ICS-SABA combinations. Discuss with your prescriber whether a switch to Foracort Respules (ICS-LABA) is appropriate.
- Rinse mouth, gargle, spit after every dose to prevent thrush and hoarseness.
- Do not co-nebulise antibiotics (DNase, colistin, hypertonic saline) in the same cup — separate sessions.
- Cardiovascular disease: caution with arrhythmias, severe coronary disease.
- Pregnancy and breastfeeding: budesonide has the most pregnancy data of any ICS; levosalbutamol is reasonable in pregnancy. Use lowest effective dose.
- Children: wipe face after mask use to remove drug residue.
Contraindications
- Hypersensitivity to budesonide, levosalbutamol, or excipients
- Untreated active fungal, bacterial, mycobacterial, or viral respiratory infection
- Uncontrolled tachyarrhythmias (relative)
Drug Interactions
| Interacting drug | Effect | What to do |
|---|---|---|
| Strong CYP3A4 inhibitors (ritonavir, ketoconazole, clarithromycin) | Raise budesonide systemic exposure → adrenal suppression risk | Avoid prolonged co-prescription |
| Non-selective beta-blockers (propranolol, timolol) | Block levosalbutamol effect — risk of severe bronchospasm | Avoid; switch to cardioselective if essential |
| Loop or thiazide diuretics | Additive hypokalaemia | Monitor potassium with high doses |
| Theophylline / aminophylline | Additive tachycardia and hypokalaemia | Monitor heart rate and potassium |
| MAOIs and tricyclic antidepressants | Potentiate β-agonist cardiovascular effects | Caution — monitor BP/HR |
Storage
- Store below 25°C, protected from direct light.
- Keep respules in their original foil overwrap until immediately before use.
- Once a respule is opened, use immediately; discard any remainder.
- Do not refrigerate. Keep out of reach of children.
Related Alternatives on MedsBase
- Budecort Respules — budesonide alone
- Levolin Respules — levosalbutamol alone
- Foracort Respules — budesonide + formoterol (long-acting alternative)
- Duolin Respules — ipratropium + levosalbutamol combination
- Asthalin Respules — salbutamol nebuliser
Frequently Asked Questions
How is Budesal different from Foracort Respules?
Budesal = budesonide + levosalbutamol (short-acting β2 agonist). Foracort = budesonide + formoterol (long-acting β2 agonist). Foracort has 12-hour bronchodilation; Budesal has 4–6 hour bronchodilation but faster onset for acute relief.
When is Budesal preferred?
For acute moderate-to-severe asthma where you want simultaneous fast bronchodilation + ICS dosing. For maintenance, Foracort Respules (ICS-LABA) is generally preferred for sustained 12-hour control.
Why must I rinse my mouth?
The budesonide ICS component can cause oral thrush and hoarseness without post-nebulisation rinsing.
Can I co-nebulise Budesal with ipratropium?
In severe acute exacerbations, adding ipratropium (Ipravent Respules) for triple bronchodilation + ICS is standard. Empty all respules into the same cup.
How fast does Budesal work?
Levosalbutamol begins bronchodilation in 1–5 minutes. Budesonide preventer effect builds over 1–2 weeks of consistent dosing.
Can children use Budesal?
Yes from 6 years in age-appropriate strength under medical guidance.
Is Budesal safe in pregnancy?
Yes — budesonide has the most pregnancy data of any ICS; levosalbutamol is reasonable in pregnancy. Use lowest effective dose.
How long does the effect last?
Levosalbutamol bronchodilation: 4–6 hours. Budesonide anti-inflammatory effect on airways persists much longer with twice-daily dosing.
Should I switch to a maintenance ICS-LABA?
For chronic management, Foracort Respules (ICS-LABA) offers 12-hour cover and SMART/MART option. Budesal is more useful for acute episode management. Discuss with your prescriber.
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| Strength | 0.5 mg, 1 mg |
|---|---|
| Quantity | 30 Respules/s, 60 Respules/s, 90 Respules/s |
| Pharma Form | Respules |
| Manufacturer | Cipla Inc |
| Treatment | Asthma, Chronic obstructive pulmonary disease (COPD) |
| Generic Brand | Budesonide + Levalbuterol |
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