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Drug Interactions between budesonide / formoterol and insulin inhalation, rapid acting

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

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Interactions between your drugs

Moderate

budesonide insulin inhalation, rapid acting

Applies to: budesonide / formoterol and insulin inhalation, rapid acting

ADJUST DOSING INTERVAL: Bronchodilators and other orally inhaled products may alter the absorption of inhaled human insulin. In nondiabetic subjects with mild asthma (n=36) and moderate asthma (n=31), administration of albuterol 30 minutes prior to inhaled human insulin resulted in a mean increase in insulin systemic exposure (AUC) and peak plasma concentration (Cmax) of 25% to 50% compared to administration of inhaled human insulin alone.

MONITOR: Systemic administration or systemic absorption of orally inhaled corticosteroids and sympathomimetic amines (bronchodilators) may result in diminished efficacy of insulin. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes.

MANAGEMENT: Consistent timing of dosing of other inhaled products relative to inhaled human insulin administration is recommended. Blood glucose should be monitored closely, and the insulin dose adjusted accordingly.

References

  1. Greenstone MA, Shaw AB (1987) "Alternate day corticosteroid causes alternate day hyperglycaemia." Postgrad Med J, 63, p. 761-4
  2. Black DM, Filak AT (1989) "Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection." J Fam Pract, 28, p. 462-3
  3. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG (1980) "Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?" Scand J Urol Nephrol Suppl, 54, p. 135-8
  4. Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R (1993) "Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans." Diabetologia, 36, p. 84-7
  5. (2006) "Product Information. EXUBERA (insulin inhalation, rapid acting)." Pfizer U.S. Pharmaceuticals Group
View all 5 references

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Moderate

formoterol insulin inhalation, rapid acting

Applies to: budesonide / formoterol and insulin inhalation, rapid acting

ADJUST DOSING INTERVAL: Bronchodilators and other orally inhaled products may alter the absorption of inhaled human insulin. In nondiabetic subjects with mild asthma (n=36) and moderate asthma (n=31), administration of albuterol 30 minutes prior to inhaled human insulin resulted in a mean increase in insulin systemic exposure (AUC) and peak plasma concentration (Cmax) of 25% to 50% compared to administration of inhaled human insulin alone.

MONITOR: Systemic administration or systemic absorption of orally inhaled corticosteroids and sympathomimetic amines (bronchodilators) may result in diminished efficacy of insulin. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes.

MANAGEMENT: Consistent timing of dosing of other inhaled products relative to inhaled human insulin administration is recommended. Blood glucose should be monitored closely, and the insulin dose adjusted accordingly.

References

  1. Greenstone MA, Shaw AB (1987) "Alternate day corticosteroid causes alternate day hyperglycaemia." Postgrad Med J, 63, p. 761-4
  2. Black DM, Filak AT (1989) "Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection." J Fam Pract, 28, p. 462-3
  3. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG (1980) "Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?" Scand J Urol Nephrol Suppl, 54, p. 135-8
  4. Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R (1993) "Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans." Diabetologia, 36, p. 84-7
  5. (2006) "Product Information. EXUBERA (insulin inhalation, rapid acting)." Pfizer U.S. Pharmaceuticals Group
View all 5 references

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Minor

budesonide formoterol

Applies to: budesonide / formoterol and budesonide / formoterol

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the potential significance is unknown. Patients who are receiving systemic or nebulized formulations of beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be at a greater risk of developing hypokalemia.

References

  1. (2001) "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
View all 4 references

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Drug and food interactions

Moderate

budesonide food

Applies to: budesonide / formoterol

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations and systemic effects of orally administered budesonide. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. According to the manufacturer, the systemic exposure of oral budesonide approximately doubles after extensive intake of grapefruit juice.

MANAGEMENT: Patients receiving budesonide should avoid the regular consumption of grapefruits and grapefruit juice to prevent undue increases in plasma budesonide levels and systemic effects.

References

  1. (2001) "Product Information. Entocort (budesonide)." AstraZeneca Pharma Inc

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Moderate

insulin inhalation, rapid acting food

Applies to: insulin inhalation, rapid acting

GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes. A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

References

  1. Jerntorp P, Almer LO (1981) "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand, 656, p. 33-6
  2. Jerntorp P, Almer LO, Holin H, et al. (1983) "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol, 24, p. 237-42
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. (1983) "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia, 24, p. 213-5
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A (1987) "Interaction of ethanol and glipizide in humans." Diabetes Care, 10, p. 683-6
  5. (2002) "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals
  6. (2002) "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM (1981) "The pharmacology of sulfonylureas." Am J Med, 70, p. 361-72
  9. (2002) "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care, 25(Suppl 1), S50-S60
  10. Cerner Multum, Inc. "UK Summary of Product Characteristics."
View all 10 references

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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.

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