How-to guide
How to Do a Budesonide Sinus Rinse
Quick answer: A budesonide rinse adds a steroid medicine to your saline sinus rinse, so the medicine washes over the lining of the nose and sinuses. Use it only if we prescribed it. You need four things: budesonide vials from the pharmacy (prescription), a sinus rinse squeeze bottle, saline packets and distilled water. Fill the bottle with room-temperature distilled water and a saline packet, add the budesonide your prescription calls for (usually one vial), mix, then rinse half the bottle through each side of your nose. Rinse as often as prescribed, usually twice a day. Mix a fresh rinse each time, and never use water straight from the tap.
What is a budesonide rinse?
Budesonide (brand name Pulmicort) is a steroid medicine that calms inflammation, the swelling and irritation of the lining of the nose and sinuses. It comes as a liquid in small plastic vials made for breathing machines (nebulizers). We prescribe it to add to a saline sinus rinse instead, which carries the medicine over a large area of the nose and sinuses.
Using budesonide this way is “off label”: it is not the use printed on the FDA label, but it is a common, well-studied treatment for chronic sinusitis, including after sinus surgery and for nasal polyps. It eases symptoms more than a plain saline rinse. Do not add budesonide, or any other medicine, to your rinse unless we prescribed it.
What do I need to buy?
Get all four of these before your first rinse.
| What to get | Where to get it | Good to know |
|---|---|---|
| Budesonide vials (Pulmicort Respules, or generic budesonide inhalation suspension) | Your pharmacy, with the prescription we send | Small plastic vials of liquid. Check the box for the strength (for example, 0.5 mg/2 mL); your prescription says how many vials to use per rinse. |
| A sinus rinse kit: an 8-ounce (240 mL) squeeze bottle, such as NeilMed Sinus Rinse | Any pharmacy, in the sinus and allergy aisle. No prescription needed. | Comes with some saline packets. A small saline spray bottle will not work for this. Already have a Navage? See below. |
| Refill saline packets | Same aisle, sold in boxes | You use one packet per rinse, so twice a day is about 60 packets a month. |
| Distilled water | Grocery store, in gallon jugs | Look for “distilled” on the label (not spring or drinking water). A gallon lasts about 8 days at two rinses a day. |
Sterile water, or tap water boiled for 1 minute and cooled, also works instead of distilled water. Tap water straight from the faucet is not sterile, and the CDC advises against using it to rinse your nose.
How do I do it?
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Wash your hands and mix the saline
Fill the clean bottle to the line with room-temperature distilled water, add one saline packet, put the cap on and shake until the powder dissolves.
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Add the budesonide
Twist the top off the vial and squeeze all of the liquid into the bottle. Use the number of vials your prescription label says for each rinse; for most people that is one. Put the cap back on and mix gently.
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Lean forward over the sink
Stand over the sink or in the shower and tilt your head forward and to one side. Keep your mouth open and breathe through your mouth.
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Rinse the first side
Place the tip snugly in the upper nostril and squeeze gently. Use about half the bottle. The rinse will flow out of the other nostril or your mouth. Spit it out and try not to swallow much of it.
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Rinse the other side
Tilt your head the other way and use the rest of the bottle in the other nostril.
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Let it drain
Lean forward and let any leftover rinse drain out, then blow gently. If you had nasal or sinus surgery in the past week, do not blow your nose; let it drain on its own.
How often should I rinse?
- Rinse as many times a day as we prescribed, usually 2. Some people are told once a day.
- Use the full amount on your prescription in each rinse (usually one whole vial), and mix a fresh rinse every time. Do not save mixed rinse for later.
- If you also use a nasal spray, rinse first, then spray.
- Keep rinsing as prescribed until we tell you otherwise, even when you feel better. We will check how it is working at your follow-up visit.
- After sinus surgery, your surgeon will tell you whether and when to start a budesonide rinse.
Can I use a Navage or other powered device?
Yes. The research on budesonide rinses used an 8-ounce (240 mL) squeeze bottle or neti pot, and adding budesonide to a powered device such as the Navage has not been studied, but the device still carries the medicine into the nose and sinuses.
Add your prescribed budesonide to the saline in the device’s water tank and run all of it through both sides, so none of the medicine is left behind. For plain saline rinses, see powered devices in our saline rinse guide.
Is it safe?
For most people, yes. Only a small amount of the medicine is absorbed into the rest of the body, so a budesonide rinse is not like taking steroid pills. Most people who use budesonide rinses every day, even for years, keep normal levels of cortisol, the body’s own steroid hormone, and the rinses do not raise eye pressure. Low cortisol is more common in people who also take steroid pills or use steroid inhalers, so tell us about any other steroid medicines you use.
A little stinging or a mild nosebleed can happen. If stinging lasts more than a week, or you have more than one nosebleed in a week, call us.
How do I store the vials?
- Keep unopened vials in their foil pouch, standing upright, at room temperature and away from light. Do not refrigerate or freeze them.
- Once you open a foil pouch, write the date on it and throw away any vials from that pouch you have not used within 2 weeks.
- If you use boiled water, keep it in a clean, covered container.
How do I keep the bottle clean?
- After each use, wash the bottle, cap and tube with warm water and a little dish soap, rinse well, and let them air-dry (or dry the inside with a paper towel).
- Follow the instructions that came with your bottle, and replace it every 3 months, or sooner if it cracks or discolors.
When should I call?
Call us for
- Nosebleeds, ear pain or real discomfort when you rinse
- Sinus symptoms that get worse, or a fever with facial pain or thick colored drainage
- Any question about your prescription or how to mix the rinse
Call 911 or go to the ER for
Swelling or redness around the eye, a change in your vision, or a severe headache with a stiff neck or confusion.
Austin 512-339-4040 · Lakeway 512-682-4798 · Marble Falls 830-992-2830
Questions patients ask
Budesonide vials from your pharmacy (with our prescription), a sinus rinse kit with an 8-ounce squeeze bottle such as NeilMed Sinus Rinse, refill saline packets, and distilled water from the grocery store. The bottle, packets and water need no prescription.
Yes. Budesonide vials are a prescription medicine. Only add budesonide, or any other medicine, to your rinse if we prescribed it.
Room-temperature distilled water. Sterile water, or tap water boiled for 1 minute and cooled, also works. Never use water straight from the tap: it is not sterile, and the CDC advises against using it to rinse your nose.
No. Mix a fresh rinse each time with the amount on your prescription (usually one vial), and use all of it.
Yes. Add the prescribed budesonide to the saline in the device's water tank and run all of it through both sides. Budesonide rinses were studied with 8-ounce squeeze bottles and neti pots, not powered devices, but the device still carries the medicine into the nose and sinuses.
For most people, yes. Only a small amount is absorbed into the body, and most people who use budesonide rinses every day, even for years, keep normal cortisol levels. Tell us about any steroid pills or inhalers you also use.
As often as we prescribed, usually 2 times a day; some people are told once a day. If you also use a nasal spray, rinse first, then spray.
This guide is for educational purposes only and does not replace an in-person evaluation. If we gave you different instructions, follow ours.
Full guide: capitalent.com/budesonide-sinus-rinse.html
Sources
- Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021. PubMed
- Smith KA, French G, Mechor B, Rudmik L. Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016. PubMed
- Silva BRC, Tyler MA, Ma Y, et al. Incidence of hypocortisolism with long-term budesonide irrigation for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2024. PubMed
- Magboul N, Alharbi AF, Alqutub AT, et al. Budesonide nasal irrigation for chronic rhinosinusitis: a meta-analysis of therapeutic outcomes and safety profile. Rhinology. 2025. PubMed
- CDC: Sinus rinsing for health or religious practice
- AstraZeneca. Pulmicort Respules (budesonide inhalation suspension) prescribing information: storage and handling.