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Drug Interactions between budesonide / formoterol / glycopyrrolate and rivastigmine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

glycopyrrolate rivastigmine

Applies to: budesonide / formoterol / glycopyrrolate and rivastigmine

Using rivastigmine together with glycopyrrolate may decrease the benefits of rivastigmine in the treatment of dementia. Rivastigmine may also counteract the benefit of glycopyrrolate. Glycopyrrolate should generally be avoided in patients with Alzheimer's disease or other cognitive problems. Glycopyrrolate may also adversely affect elderly patients by producing symptoms ranging from mild thinking impairment to delirium. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor.

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Moderate

budesonide rivastigmine

Applies to: budesonide / formoterol / glycopyrrolate and rivastigmine

Consumer information for this interaction is not currently available.

MONITOR: Concomitant use of acetylcholinesterase inhibitors and corticosteroids or adrenocorticotropic agents may result in severe muscle weakness in patients with myasthenia gravis. The mechanism of the interaction is unknown. It has been suggested that corticosteroids at high doses have a direct effect on neuromuscular transmission. Marked deterioration in muscle strength has been reported in patients with myasthenia gravis shortly after the initiation of corticosteroid therapy, particularly when high dosages were used. The use of cortisone appears to be associated with the highest rate of myasthenia gravis exacerbation, with an intermediate rate for prednisone and the lowest rate for methylprednisolone. In most cases, the decline in muscular function was relatively refractory to acetylcholinesterase inhibitors. However, clinical improvement generally occurs during prolonged corticosteroid therapy when administered properly.

MANAGEMENT: Caution and monitoring for muscle weakness is recommended with the use of corticosteroids or adrenocorticotropic agents in combination with acetylcholinesterase inhibitors in the treatment of patients with myasthenia gravis. Prednisone or prednisolone are often considered part of the standard treatment for this condition. Recommendations in the medical literature have advised that corticosteroid therapy should be instituted at relatively low dosages and in a controlled setting in patients with myasthenia gravis. Respiratory support should be available, and the dosage should be increased stepwise as tolerated. Dose reductions of the acetylcholinesterase inhibitor may be required as symptoms improve, which often may be delayed and gradual. However, according to some manufacturers of the corticosteroids dexamethasone and triamcinolone, anticholinesterase agents should be discontinued at least 24 hours before initiating corticosteroid therapy in patients with myasthenia gravis. Other management recommendations in the medical literature suggest avoiding the use of corticosteroids at high doses; however, if high doses are required, consider pre-treatment with intravenous immunoglobulin or plasmapheresis. Local protocols and/or the manufacturer's product labeling should be consulted for specific guidance.

Moderate

rivastigmine formoterol

Applies to: rivastigmine and budesonide / formoterol / glycopyrrolate

Consumer information for this interaction is not currently available.

MONITOR: Acetylcholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes, which occasionally manifest as bradycardia or heart block (<2%). Because bradycardia is a risk factor for torsade de pointes, a theoretical risk exists when combined with agents that prolong the QT interval. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors including, but not limited to congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation may vary depending on the dosage(s) and specific drug(s) involved.

MANAGEMENT: Caution is advised when acetylcholinesterase inhibitors are used with drugs that can prolong the QT interval. Patients should be monitored for bradycardia, atrioventricular block and syncope, and advised to seek medical attention if they experience dizziness, lightheadedness, fainting, shortness of breath, or slow or irregular heartbeat.

Minor

budesonide formoterol

Applies to: budesonide / formoterol / glycopyrrolate and budesonide / formoterol / glycopyrrolate

Information for this minor interaction is available on the professional version.

Drug and food interactions

Moderate

budesonide food

Applies to: budesonide / formoterol / glycopyrrolate

You should avoid the regular consumption of large amounts of grapefruits and grapefruit juice while taking budesonide. Grapefruit can raise the levels of budesonide in your body and lead to increased side effects. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

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Moderate

glycopyrrolate food

Applies to: budesonide / formoterol / glycopyrrolate

Ask your doctor before using glycopyrrolate together with ethanol. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking glycopyrrolate. You should be warned not to exceed recommended dosages and to avoid activities requiring mental alertness. If your doctor prescribes these medications together, you may need a dose adjustment to safely take this combination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.