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Breztri Aerosphere Disease Interactions

There are 26 disease interactions with Breztri Aerosphere (budesonide / formoterol / glycopyrrolate).

Major

Anticholinergics (applies to Breztri Aerosphere) arrhythmias

Major Potential Hazard, High plausibility.

Patients with tachycardia should be supervised closely during treatment with anticholinergic agents. Tachycardia is produced by blocking normal vagal inhibition of the SA node. Paradoxically, bradycardia may occur due to central vagal stimulation which may occur prior to peripheral cholinergic blockade.

References

  1. Blumensohn R, Razoni G, Shalev A, Munitz H (1986) "Bradycardia due to trihexyphenidyl hydrochloride." Drug Intell Clin Pharm, 20, p. 786-7
  2. Voinov H, Elefante V, Mujica R (1992) "Sinus bradycardia related to the use of benztropine mesylate." Am J Psychiatry, 149, p. 711
  3. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
Major

Anticholinergics (applies to Breztri Aerosphere) autonomic neuropathy

Major Potential Hazard, High plausibility.

Agents with anticholinergic activity can exacerbate many of the manifestations of autonomic neuropathy, including tachycardia, anhidrosis, bladder atony, obstipation, dry mouth and eyes, cycloplegia and blurring of vision, and sexual impotence in males. Therapy with antimuscarinic agents and higher dosages of antispasmodic agents (e.g., dicyclomine or oxybutynin) should be administered cautiously in patients with autonomic neuropathy.

References

  1. (2022) "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics
Major

Anticholinergics (applies to Breztri Aerosphere) GI obstruction

Major Potential Hazard, High plausibility. Applicable conditions: Gastrointestinal Obstruction, Esophageal Obstruction

Anticholinergics are contraindicated in patients with obstructive diseases such as achalasia, esophageal stricture or stenosis, pyloroduodenal stenosis, stenosing peptic ulcer, pyloric obstruction, and paralytic ileus. Anticholinergics may further suppress intestinal motility with resultant precipitation or aggravation of toxic megacolon.

References

  1. Bantz EW, Dolen WK, Chadwick EW, Nelson HS (1987) "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy, 59, p. 341-6
  2. Simons FE, Frith EM, Simons KJ (1982) "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol, 70, p. 458-64
  3. Blamoutier J (1978) "Comparative trial of two antihistamines, mequitazine and brompheniramine." Curr Med Res Opin, 5, p. 366-70
  4. (1977) "Azatadine (optimine)--a new antihistamine." Med Lett Drugs Ther, 19, p. 77-9
  5. (2002) "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories
  6. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  7. (2002) "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc
  8. (2002) "Product Information. Benadryl (diphenhydramine)." Parke-Davis
  9. (2001) "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories
  10. (2001) "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation
  11. (2001) "Product Information. Antivert (meclizine)." Roerig Division
  12. (2001) "Product Information. Optimine (azatadine)." Schering Corporation
  13. Mevorach D (1992) "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother, 26, p. 564
  14. (2022) "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics
  15. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
  16. (2001) "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company
View all 16 references
Major

Anticholinergics (applies to Breztri Aerosphere) glaucoma

Major Potential Hazard, High plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

Anticholinergic agents are contraindicated in patients with primary glaucoma, a tendency toward glaucoma (narrow anterior chamber angle), or adhesions (synechiae) between the iris and lens, as well as for the elderly and others in whom undiagnosed glaucoma or excessive pressure in the eye may be present. Because anticholinergics cause mydriasis, they may exacerbate these conditions.

References

  1. Schuller DE, Turkewitz D (1986) "Adverse effects of antihistamines." Postgrad Med, 79, p. 75-86
  2. (2002) "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories
  3. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  4. (2002) "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham
  5. (2002) "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc
  6. (2002) "Product Information. Benadryl (diphenhydramine)." Parke-Davis
  7. (2001) "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories
  8. (2001) "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation
  9. (2001) "Product Information. Optimine (azatadine)." Schering Corporation
  10. O'Connor PS, Mumma JV (1985) "Atropine toxicity." Am J Ophthalmol, 99, p. 613-4
  11. Clearkin LG (1992) "Angle closure glaucoma precipitated by atropine." Arch Intern Med, 152, p. 880
  12. Berdy GJ, Berdy SS, Odin LS, Hirst LW (1991) "Angle closure glaucoma precipitated by aerosolized atropine." Arch Intern Med, 151, p. 1658-60
  13. Pecora JL (1979) "Malignant glaucoma worsened by miotics in a postoperative angle- closure glaucoma patient." Ann Ophthalmol, 11, p. 1412-4
  14. Holland MG (1974) "Autonomic drugs in ophthalmology: some problems and promises. Section II: Anticholinergic drugs." Ann Ophthalmol, 6, p. 661-4
  15. Kanto J (1983) "New aspects in the use of atropine." Int J Clin Pharmacol Ther Toxicol, 21, p. 92-4
  16. (2022) "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics
  17. (2001) "Product Information. Compazine (prochlorperazine)." SmithKline Beecham
  18. Goldstein JH (1971) "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin, 11, p. 13-34
  19. (2001) "Product Information. Cogentin (benztropine)." Merck & Co., Inc
  20. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
  21. (2001) "Product Information. Moban (molindone)." Gate Pharmaceuticals
  22. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  23. (2001) "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company
View all 23 references
Major

Anticholinergics (applies to Breztri Aerosphere) obstructive uropathy

Major Potential Hazard, High plausibility. Applicable conditions: Urinary Retention

In general, the use of anticholinergic agents is contraindicated in patients with urinary retention and bladder neck obstruction caused by prostatic hypertrophy. Dysuria may occur and may require catheterization. Also, anticholinergic drugs may aggravate partial obstructive uropathy. Caution is advised even when using agents with mild to moderate anticholinergic activity, particularly in elderly patients.

References

  1. Bantz EW, Dolen WK, Chadwick EW, Nelson HS (1987) "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy, 59, p. 341-6
  2. Schuller DE, Turkewitz D (1986) "Adverse effects of antihistamines." Postgrad Med, 79, p. 75-86
  3. (2002) "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories
  4. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  5. (2002) "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham
  6. (2002) "Product Information. Periactin (cyproheptadine)." Merck & Co., Inc
  7. (2002) "Product Information. Benadryl (diphenhydramine)." Parke-Davis
  8. (2001) "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories
  9. (2001) "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation
  10. (2001) "Product Information. Antivert (meclizine)." Roerig Division
  11. (2001) "Product Information. Optimine (azatadine)." Schering Corporation
  12. Shutt LE, Bowes JB (1979) "Atropine and hyoscine." Anaesthesia, 34, p. 476-90
  13. O'Kelly SW, Spargo PM (1991) "Postoperative urinary retention in men." BMJ, 302, p. 1403-4
  14. (2022) "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics
  15. (2001) "Product Information. Compazine (prochlorperazine)." SmithKline Beecham
  16. (2001) "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals
  17. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
  18. (2001) "Product Information. Moban (molindone)." Gate Pharmaceuticals
  19. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  20. (2001) "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company
View all 20 references
Major

Anticholinergics (applies to Breztri Aerosphere) tardive dyskinesia

Major Potential Hazard, High plausibility.

Anticholinergic agents and agents with secondary anticholinergic activity may aggravate tardive dyskinesia or induce previously suppressed symptoms. Therapy with these agents should be avoided, if possible, or administered cautiously in patients with preexisting tardive dyskinesia, particularly in the elderly. If tardive dyskinesia symptoms develop or worsen during treatment with an anticholinergic agent, prompt withdrawal of therapy will provide better chances of improving the condition.

References

  1. Brait KA, Zagerman AJ (1977) "Dyskinesias after antihistamine use ." N Engl J Med, 296, p. 111
  2. Jones B, Lal S (1985) "Tardive dyskinesia uncovered after ingestion of Sominex, an over-the- counter drug." Can J Psychiatry, 30, p. 370-1
  3. (2002) "Product Information. Benadryl (diphenhydramine)." Parke-Davis
  4. Yassa R (1985) "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry, 30, p. 440-2
  5. Burnett GB, Prange AJ Jr, Wilson IC, Jolliff LA, Creese IC, Synder SH (1980) "Adverse effects of anticholinergic antiparkinsonian drugs in tardive dyskinesia. An investigation of mechanism." Neuropsychobiology, 6, p. 109-20
  6. Kiloh LG, Smith JS, Williams SE (1973) "Antiparkinson drugs as causal agents in tardive dykinesia." Med J Aust, 2, p. 591-3
  7. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
View all 7 references
Major

Antiperistaltic agents (applies to Breztri Aerosphere) infectious diarrhea

Major Potential Hazard, High plausibility. Applicable conditions: Infectious Diarrhea/Enterocolitis/Gastroenteritis

The use of drugs with antiperistaltic activity (primarily antidiarrheal and antimuscarinic agents, but also antispasmodic agents such as dicyclomine or oxybutynin at high dosages) is contraindicated in patients with diarrhea due to pseudomembranous enterocolitis or enterotoxin-producing bacteria. These drugs may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella and Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. In general, because antiperistaltic agents decrease gastrointestinal motility, they may delay the excretion of infective gastroenteric organisms or toxins and should be used cautiously in patients with any infectious diarrhea, particularly if accompanied by high fever or pus or blood in the stool. Some cough and cold and other combination products may occasionally include antimuscarinic agents for their drying effects and may, therefore, require careful selection when necessary.

References

  1. Brown JW (1979) "Toxic megacolon associated with loperamide therapy." JAMA, 241, p. 501-2
  2. Walley T, Milson D (1990) "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J, 66, p. 582
  3. (2001) "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals
  4. Marshall WF Jr, Rosenthal P, Merritt RJ (1989) "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr, 9, p. 532-4
  5. (1975) "Lomotil for diarrhea in children." Med Lett Drugs Ther, 17, p. 104
  6. (2022) "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics
View all 6 references
Major

Glycopyrrolate (applies to Breztri Aerosphere) myasthenia gravis

Major Potential Hazard, Moderate plausibility.

The use of glycopyrrolate is contraindicated in patients with myasthenia gravis.

References

  1. (2010) "Product Information. Cuvposa (glycopyrrolate)." Shionogi USA Inc
Major

Glycopyrrolate (applies to Breztri Aerosphere) ulcerative colitis

Major Potential Hazard, Moderate plausibility.

Glycopyrrolate is contraindicated in patients with severe ulcerative colitis and toxic mega-colon complicating ulcerative colitis.

References

  1. (2023) "Product Information. Prevduo (glycopyrrolate-neostigmine)." Slayback Pharma LLC
Moderate

Antimuscarinics (applies to Breztri Aerosphere) psychoses

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis

Toxic psychosis manifested as confusion, disorientation, agitation, excitation, memory impairment, delusions and hallucinations may develop at toxic and therapeutic dosages of antimuscarinic agents. Therapy with these agents should be administered cautiously in patients with mental disorders receiving antimuscarinic agents for control of drug-induced extrapyramidal effects, especially at the beginning of therapy or during dosage adjustment. Psychiatric deterioration and psychotic flare-ups have also been reported following withdrawal of therapy. Symptoms include delusions, hallucinations, aggression or violent behavior, and suicidal tendencies. In high dosages, antimuscarinic agents may sometimes produce euphorigenic effects. For this reason, it can be a drug of abuse.

References

  1. Jellinek T, Gardos G, Cole JO (1981) "Adverse effects of antiparkinson drug withdrawal." Am J Psychiatry, 138, p. 1567-71
  2. Goggin DA, Solomon GF (1979) "Trihexyphenidyl abuse for euphorigenic effect." Am J Psychiatry, 136, p. 459-60
  3. Macvicar K (1977) "Abuse of antiparkinsonian drugs by psychiatric patients." Am J Psychiatry, 134, p. 809-11
  4. Craig DH, Rosen P (1981) "Abuse of antiparkinsonian drugs." Ann Emerg Med, 10, p. 98-100
  5. Pullen GP, Best NR, Maguire J (1984) "Anticholinergic drug abuse: a common problem?" Br Med J (Clin Res Ed), 289, p. 612-3
  6. Rubinstein JS (1978) "Abuse of antiparkinsonism drugs. Feigning of extrapyramidal symptoms to obtain trihexyphenidyl." JAMA, 239, p. 2365-6
  7. McInnis M, Petursson H (1984) "Trihexyphenidyl dependence." Acta Psychiatr Scand, 69, p. 538-42
  8. Mohan D, Mohandas E, Dube S (1981) "Trihexyphenidyl abuse." Br J Addict, 76, p. 195-7
  9. Kaminer Y, Munitz H, Wijsenbeek H (1982) "Trihexyphenidyl (Artane) abuse: euphoriant and anxiolytic." Br J Psychiatry, 140, p. 473-4
  10. Warnes H (1967) "Toxic psychosis due to antiparkinsonian drugs." Can Psychiatr Assoc J, 12, p. 323-6
  11. Hidalgo HA, Mowers RM (1990) "Anticholinergic drug abuse." DICP, 24, p. 40-1
  12. Wilcox JA (1983) "Psychoactive properties of benztropine and trihexyphenidyl." J Psychoactive Drugs, 15, p. 319-21
  13. Laski E, Taleporos E (1977) "Anticholinergic psychosis in a bilingual: a case study." Am J Psychiatry, 134, p. 1038-40
  14. Brower KJ (1987) "Smoking of prescription anticholinergic drugs." Am J Psychiatry, 144, p. 383
  15. Baker LA, Cheng LY, Amara IB (1983) "The withdrawal of benztropine mesylate in chronic schizophrenic patients." Br J Psychiatry, 143, p. 584-90
  16. Moreau A, Jones BD, Banno V (1986) "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry, 31, p. 339-41
  17. Yassa R (1985) "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry, 30, p. 440-2
  18. Ananth JV, Jain RC (1973) "Benztropine psychosis." Can Psychiatr Assoc J, 18, p. 409-14
  19. Woody GE, O'Brien CP (1974) "Anticholinergic toxic psychosis in drug abusers treated with benztropine." Compr Psychiatry, 15, p. 439-42
  20. (2001) "Product Information. Cogentin (benztropine)." Merck & Co., Inc
  21. Kulik AV, Wilbur R (1982) "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry, 6, p. 75-82
  22. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
View all 22 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to Breztri Aerosphere) cardiovascular

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hypertension, Hyperthyroidism, Heart Disease

Adrenergic bronchodilators can stimulate cardiovascular beta- 1 and beta- 2 receptors, resulting in adverse effects such as tachycardia, palpitation, peripheral vasodilation, blood pressure changes, and ECG changes (e.g., flattening of the T wave; prolongation of the QT interval; ST segment depression). Direct stimulation of cardiac tissues is mediated by beta- 1 receptors and thus less likely to occur with beta-2-selective agents such as albuterol. However, beta-2-selectivity is not absolute and can be lost with larger doses. High dosages of these agents have been associated with precipitation or aggravation of angina, myocardial ischemia, and cardiac arrhythmias. Therapy with adrenergic bronchodilators should be administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, and/or underlying cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, or hypertension. The recommended dosages should not be exceeded.

References

  1. Chazan R, Droszcz W, Maruchin JE (1988) "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol, 26, p. 385-7
  2. Larsson S (1977) "Long-term treatment with beta2-adrenostimulants in asthma. Side effects, selectivity, tolerance, and routes of administration." Acta Med Scand Suppl, 608, p. 1-40
  3. Mettauer B, Rouleau JL, Burgess JH (1985) "Detrimental arrhythmogenic and sustained beneficial hemodynamic effects of oral salbutamol in patients with chronic congestive heart failure." Am Heart J, 109, p. 840-7
  4. Larsson S, Svedmyr N (1977) "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis, 116, p. 861-9
  5. Vathenen AS, Britton JR, Ebden P, Cookson JB, Wharrad HJ, Tattersfield AE (1988) "High-dose inhaled albuterol in severe chronic airflow limitation." Am Rev Respir Dis, 138, p. 850-5
  6. Godfrey S (1981) "Worldwide experience with albuterol (salbutamol)." Ann Allergy, 47, p. 423-6
  7. Finch JS (1981) "Cardiovascular toxicity: clinical evaluation of albuterol, isoproterenol and placebo in rising dose tolerance trial." Ann Allergy, 47, p. 402-4
  8. Neville E, Corris PA, Vivian J, Nariman S, Gibson GJ (1982) "Nebulised salbutamol and angina." Br Med J (Clin Res Ed), 285, p. 796-7
  9. Breeden CC, Safirstein BH (1990) "Albuterol and spacer-induced atrial fibrillation." Chest, 98, p. 762-3
  10. Wolfe JD, Yamate M, Biedermann AA, Chu TJ (1985) "Comparison of the acute cardiopulmonary effects of oral albuterol, metaproterenol, and terbutaline in asthmatics." JAMA, 253, p. 2068-72
  11. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE (1990) "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet, 336, p. 1396-9
  12. Shovlin CL, Tam FW (1990) "Salbutamol nebuliser and precipitation of critical cardiac ischaemia." Lancet, 336, p. 1258
  13. Spitzer WO, Suissa S, Ernst P, Horwitz RI, Habbick B, Cockcroft D, Boivin JF, McNutt M, Buist AS, Rebuck AS (1992) "The use of beta-agonists and the risk of death and near death from asthma." N Engl J Med, 326, p. 501-6
  14. Price AH, Clissold SP (1989) "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs, 38, p. 77-122
  15. Richards DM, Brogden RN (1985) "Pirbuterol. A preliminary review of its pharmacological properties and therapeutic efficacy in reversible bronchospastic disease." Drugs, 30, p. 6-21
  16. Lampert MB, Hibbard J, Weinert L, Briller J, Lindheimer M, Lang RM (1993) "Peripartum heart failure associated with prolonged tocolytic therapy." Am J Obstet Gynecol, 168, p. 493-5
  17. Al-Hillawi AH, Hayward R, Johnson NM (1984) "Incidence of cardiac arrhythmias in patients taking slow release salbutamol and slow release terbutaline for asthma." Br Med J (Clin Res Ed), 288, p. 367
  18. Bengtsson B, Fagerstrom PO (1982) "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther, 31, p. 726-32
  19. (1985) "Adverse effects and complications of treatment with beta-adrenergic agonist drugs. Committee on drugs, the American Academy of Allergy and Immunology." J Allergy Clin Immunol, 75, p. 443-9
  20. Wagner JM, Morton MJ, Johnson KA, O'Grady JP, Speroff L (1981) "Terbutaline and maternal cardiac function." JAMA, 246, p. 2697-701
  21. Kinney EL, Trautlein JJ, Harbaugh CV, Lambert D, Zelis RF (1978) "Ventricular tachycardia after terbutaline." JAMA, 240, p. 2247
  22. Whitsett TL, Manion CV, Wilson MF (1981) "Cardiac, pulmonary and neuromuscular effects of clenbuterol and terbutaline compared with placebo." Br J Clin Pharmacol, 12, p. 195-200
  23. Brogden RN, Speight TM, Avery GS (1973) "Terbutaline: a preliminary report of its pharmacological properties and therapeutic efficacy in asthma." Drugs, 6, p. 324-32
  24. Trautlein J, Allegra J, Gillin M (1977) "Aerosolized terbutaline sulfate--an evalution of efficacy and side effects in patients with reversible airway disease." J Clin Pharmacol, 17, p. 76-80
  25. Maguire GP, Emirgil C (1986) "Bronchodilator and side effects of different modes of administration of metaproterenol: inhaled, oral, and in combination." Am J Med Sci, 291, p. 168-74
  26. Ence TJ, Tashkin DP, Ho D, Child JS (1979) "Acute bronchial and cardiovascular effects of oral pirbuterol and metaproterenol." Ann Allergy, 43, p. 229-36
  27. Sanders JP, Potter DE, Ellis S, Bee DE, Grant JA (1977) "Metabolic and cardiovascular effects of carbuterol and metaproterenol." J Allergy Clin Immunol, 60, p. 174-9
  28. (2002) "Product Information. Proventil (albuterol)." Schering Corporation
  29. (2002) "Product Information. Ventolin (albuterol)." Glaxo Wellcome
  30. (2001) "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals
  31. Meyer JM, Wenzel CL, Kradjan WA (1993) "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother, 27, p. 1478-87
  32. Maconochie JG, Forster JK (1992) "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol, 33, p. 342-5
  33. Brogden RN, Faulds D (1991) "Salmeterol xinafoate. A review of its pharmacological properties and therapeutic potential in reversible obstructive airways disease." Drugs, 42, p. 895-912
  34. Littner MR, Tashkin DP, Calvarese B, Bautista M (1982) "Acute bronchial and cardiovascular effects of increasing doses of pirbuterol acetate aerosol in asthma." Ann Allergy, 48, p. 14-20
  35. Chodosh S, Crooks LA, Tuck J (1989) "Comparative effects of pirbuterol acetate, metaproterenol, and placebo aerosols on pulmonary function and incidence of cardiac ectopy." J Asthma, 26, p. 309-15
  36. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  37. (2001) "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals
  38. (2001) "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim
  39. Hibbard JU (1996) "Chronic terbutaline therapy and peripartum cardiomyopathy: a case-control study." Hypertens Pregnancy, 15, p. 183-91
  40. Katz M, Robertson PA, Creasy RK (1981) "Cardiovascular complications associated with terbutaline treatment for preterm labor." Am J Obstet Gynecol, 139, p. 605-8
  41. Suissa S, Hemmelgarn B, Blais L, Ernst P (1996) "Bronchodilators and acute cardiac death." Am J Respir Crit Care Med, 154, p. 1598-602
  42. Tranfa CME, Pelaia G, Grembiale RD, Naty S, Durante S, Borrello G (1998) "Short-term cardiovascular effects of salmeterol." Chest, 113, p. 1272-6
  43. Braden GL, Germain MJ, Mulhern JG, Hafer JG, Bria WF (1998) "Hemodynamic, cardiac, and electrolyte effects of low-dose aerosolized terbutaline sulfate in asthmatic patients." Chest, 114, p. 380-7
  44. Jenne JW (1998) "Can oral beta(2) agonists cause heart failure?" Lancet, 352, p. 1081-2
  45. (2022) "Product Information. Tornalate (bitolterol)." Apothecon Inc
  46. Nathan RA, Bronsky EA, Dockhorn RJ, Kemp JP (1994) "Multicenter dose-ranging study of bitolterol mesylate solution for nebulization in children with asthma." Ann Allergy, 72, p. 209-16
  47. Bierman CW, Kemp JP, Nathan RA (1996) "Efficacy and safety of inhaled bitolterol mesylate via metered-dose inhaler in children with asthma." Ann Allergy Asthma Immunol, 76, p. 27-35
  48. Pinnas JL, Bhatt BD, Campbell SC, Kemp JP, Tinkelman DG (1987) "Dose-response study of nebulized bitolterol mesylate solution in asthmatic patients." Chest, 91, p. 533-9
  49. (2001) "Product Information. Xopenex (levalbuterol)." Sepracor Inc
  50. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS (1999) "The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients." J Allerg Clin Immunol, 103, p. 615-21
  51. (2014) "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim
View all 51 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to Breztri Aerosphere) diabetes

Moderate Potential Hazard, Low plausibility. Applicable conditions: Diabetes Mellitus

Adrenergic bronchodilators may cause increases in blood glucose concentrations. These effects are usually transient and slight, but may be significant with dosages higher than those normally recommended. Large doses of IV albuterol (not commercially available in the U.S.) and terbutaline sulfate have been reported to cause exacerbation of preexisting diabetes mellitus and ketoacidosis. Therapy with adrenergic bronchodilators should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate. Systemic adverse effects are minimized, but not abolished, by administration of these agents via oral inhalation.

References

  1. Chazan R, Droszcz W, Maruchin JE (1988) "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol, 26, p. 385-7
  2. Hastwell G, Lambert BE (1978) "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol, 85, p. 767-9
  3. Price AH, Clissold SP (1989) "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs, 38, p. 77-122
  4. Bengtsson B, Fagerstrom PO (1982) "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther, 31, p. 726-32
  5. (2002) "Product Information. Proventil (albuterol)." Schering Corporation
  6. (2002) "Product Information. Ventolin (albuterol)." Glaxo Wellcome
  7. (2001) "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals
  8. Meyer JM, Wenzel CL, Kradjan WA (1993) "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother, 27, p. 1478-87
  9. Maconochie JG, Forster JK (1992) "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol, 33, p. 342-5
  10. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  11. (2001) "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals
  12. (2001) "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim
  13. (2022) "Product Information. Tornalate (bitolterol)." Apothecon Inc
  14. (2001) "Product Information. Xopenex (levalbuterol)." Sepracor Inc
  15. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS (1999) "The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients." J Allerg Clin Immunol, 103, p. 615-21
  16. (2001) "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals
  17. (2014) "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim
View all 17 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to Breztri Aerosphere) hypokalemia

Moderate Potential Hazard, Moderate plausibility.

Adrenergic bronchodilators may cause decreases in serum potassium concentrations, primarily when given by nebulization or intravenous administration. Although this effect is usually transient and does not require supplementation, clinically significant hypokalemia may occur in some patients, with the potential to induce cardiovascular adverse effects. The relevance of these observations to oral or oral aerosol/powder for inhalation therapy is unknown. Therapy with adrenergic bronchodilators should be administered cautiously in patients with or predisposed to hypokalemia.

References

  1. Whyte KF, Addis GJ, Whitesmith R, Reid JL (1987) "The mechanism of salbutamol-induced hypokalaemia." Br J Clin Pharmacol, 23, p. 65-71
  2. Larsson S, Svedmyr N (1977) "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis, 116, p. 861-9
  3. Allon M, Dunlay R, Copkney C (1989) "Nebulized albuterol for acute hyperkalemia in patients on hemodialysis." Ann Intern Med, 110, p. 426-9
  4. Hastwell G, Lambert BE (1978) "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol, 85, p. 767-9
  5. (1981) "Hypokalaemia due to salbutamol overdosage." Br Med J (Clin Res Ed), 283, p. 500-1
  6. Kantola I, Tarssanen L (1986) "Hypokalemia from usual salbutamol dosage ." Chest, 89, p. 619-20
  7. Montoliu J, Almirall J, Ponz E, Campistol JM, Revert L (1990) "Treatment of hyperkalaemia in renal failure with salbutamol inhalation." J Intern Med, 228, p. 35-7
  8. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE (1990) "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet, 336, p. 1396-9
  9. Price AH, Clissold SP (1989) "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs, 38, p. 77-122
  10. Gross TL, Sokol RJ (1980) "Severe hypokalemia and acidosis: a potential complication of beta- adrenergic treatment." Am J Obstet Gynecol, 138, p. 1225-6
  11. Hurlbert BJ, Edelman JD, David K (1981) "Serum potassium levels during and after terbutaline." Anesth Analg, 60, p. 723-5
  12. Bengtsson B, Fagerstrom PO (1982) "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther, 31, p. 726-32
  13. Gelmont DM, Balmes JR, Yee A (1988) "Hypokalemia induced by inhaled bronchodilators." Chest, 94, p. 763-6
  14. Sanders JP, Potter DE, Ellis S, Bee DE, Grant JA (1977) "Metabolic and cardiovascular effects of carbuterol and metaproterenol." J Allergy Clin Immunol, 60, p. 174-9
  15. (2002) "Product Information. Proventil (albuterol)." Schering Corporation
  16. (2002) "Product Information. Ventolin (albuterol)." Glaxo Wellcome
  17. (2001) "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals
  18. Meyer JM, Wenzel CL, Kradjan WA (1993) "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother, 27, p. 1478-87
  19. Maconochie JG, Forster JK (1992) "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol, 33, p. 342-5
  20. Windom H, Grainger J, Burgess C, Crane J, Pearce N, Beasley R (1990) "A comparison of the haemodynamic and hypokalaemic effects of inhaled pirbuterol and salbutamol." N Z Med J, 103, p. 259-61
  21. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  22. (2001) "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals
  23. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K (1994) "Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta(2)-adrenergic stimulation with terbutaline in healthy subjects." Chest, 106, p. 1654-9
  24. (2001) "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim
  25. Braden GL, vonOeyen PT, Germain MJ, Watson DJ, Haag BL (1997) "Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences." Kidney Int, 51, p. 1867-75
  26. Rakhmanina NY, Kearns GL, Farrar HC (1998) "Hypokalemia in an asthmatic child from abuse of albuterol metered dose inhaler." Pediatr Emerg Care, 14, p. 145-7
  27. (2022) "Product Information. Tornalate (bitolterol)." Apothecon Inc
  28. (2001) "Product Information. Xopenex (levalbuterol)." Sepracor Inc
  29. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS (1999) "The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients." J Allerg Clin Immunol, 103, p. 615-21
  30. (2014) "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim
View all 30 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to Breztri Aerosphere) seizures

Moderate Potential Hazard, Low plausibility.

Adrenergic bronchodilators may cause CNS stimulation. Therapy with adrenergic bronchodilators should be administered cautiously in patients with seizure disorders. Systemic adverse effects are minimized, but not abolished, by administration of these agents via oral inhalation.

References

  1. Larsson S, Svedmyr N (1977) "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis, 116, p. 861-9
  2. Price AH, Clissold SP (1989) "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs, 38, p. 77-122
  3. (2002) "Product Information. Proventil (albuterol)." Schering Corporation
  4. (2002) "Product Information. Ventolin (albuterol)." Glaxo Wellcome
  5. (2001) "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals
  6. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  7. (2001) "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals
  8. (2001) "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim
  9. (2022) "Product Information. Tornalate (bitolterol)." Apothecon Inc
  10. (2001) "Product Information. Xopenex (levalbuterol)." Sepracor Inc
  11. (2001) "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals
  12. (2014) "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim
View all 12 references
Moderate

Budesonide (applies to Breztri Aerosphere) hepatic impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Formal pharmacokinetic studies using budesonide inhalation suspension have not been conducted in patients with hepatic impairment. However, since budesonide is predominantly cleared by hepatic metabolism, impairment of liver function may lead to accumulation of budesonide in plasma. Patients with hepatic disease should be monitored closely.

Moderate

Glycopyrrolate (applies to Breztri Aerosphere) Down's syndrome

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Intellectual Disability, Brain Anomalies - Congenital

Anticholinergics may cause increased side effects in pediatric patients with Down's syndrome, spastic paralysis, and other brain anomalies.

References

  1. (2023) "Product Information. Prevduo (glycopyrrolate-neostigmine)." Slayback Pharma LLC
Moderate

Glycopyrrolate (applies to Breztri Aerosphere) liver impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

The pharmacokinetics of glycopyrrolate in hepatically impaired patients is unknown, however, caution is advised since anticholinergics can worsen this condition.

References

  1. (2023) "Product Information. Prevduo (glycopyrrolate-neostigmine)." Slayback Pharma LLC
Moderate

Glycopyrrolate (applies to Breztri Aerosphere) renal impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Elimination of glycopyrrolate may be severely impaired in renal failure. Use caution when administering glycopyrrolate to patients with impaired renal function, and they should be closely monitored while under the effect of the neuromuscular blocking agent.

References

  1. (2023) "Product Information. Prevduo (glycopyrrolate-neostigmine)." Slayback Pharma LLC
Moderate

Inhaled corticosteroids (applies to Breztri Aerosphere) hepatic impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Corticosteroids are predominantly cleared by hepatic metabolism and impairment of the liver function may lead to their accumulation. Patients with hepatic disease should be closely monitored.

References

  1. (2001) "Product Information. Flovent (fluticasone)." Glaxo Wellcome
  2. (2005) "Product Information. Asmanex Twisthaler (mometasone)." Schering-Plough Corporation
  3. (2015) "Product Information. Beconase AQ (beclomethasone nasal)." GlaxoSmithKline
  4. (2016) "Product Information. Pulmicort Flexhaler (budesonide)." A-S Medication Solutions
View all 4 references
Moderate

Inhaled corticosteroids (applies to Breztri Aerosphere) hyperadrenocorticism

Moderate Potential Hazard, Moderate plausibility.

The use of inhaled and nasal corticosteroids may rarely precipitate or aggravate conditions of hyperadrenocorticism. Although adverse effects of corticosteroids may be minimized by local rather than systemic administration, the risks are not entirely abolished. Inhaled and nasally applied drug may be absorbed into the circulation, especially when large doses are used. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used. The development of symptoms such as menstrual irregularities, acneiform lesions, cataracts and cushingoid features during inhaled or nasal corticosteroid therapy may indicate excessive use.

References

  1. Kimmerle R, Rolla AR (1985) "Iatrogenic Cushing's syndrome due to dexamethasone nasal drops." Am J Med, 79, p. 535-7
  2. Monk B, Cunliffe WJ, Layton AM, Rhodes DJ (1993) "Acne induced by inhaled corticosteroids." Clin Exp Dermatol, 18, p. 148-50
  3. Brogden RN, Heel RC, Speight TM, Avery GS (1984) "Beclomethasone dipropionate. A reappraisal of its pharmacodynamic properties and therapeutic efficacy after a decade of use in asthma and rhinitis." Drugs, 28, p. 99-126
  4. Clark TJ (1982) "Safety of inhaled corticosteroids." Eur J Respir Dis Suppl, 122, p. 235-42
  5. Messerli C, Studer H, Scherrer M (1975) "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie, 153, p. 29-42
  6. (2001) "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome
  7. (2001) "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome
  8. (2022) "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals
  9. (2001) "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc
  10. van As A, Bronsky E, Grossman J, Meltzer E, Ratner P, Reed C (1991) "Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis." Ann Allergy, 67, p. 156-62
  11. Stevens DJ (1988) "Cushing's syndrome due to the abuse of betamethasone nasal drops." J Laryngol Otol, 102, p. 219-21
  12. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A (1994) "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol, 38, p. 521-5
  13. Edsbacker S, Andersson KE, Ryrfeldt A (1985) "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol, 29, p. 477-81
  14. (2001) "Product Information. Flonase (fluticasone)." Glaxo Wellcome
  15. Barnes PJ (1995) "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med, 332, p. 868-75
  16. (2001) "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals
  17. Robinson DS, Geddes DM (1996) "Inhaled corticosteroids: benefits and risks." J Asthma, 33, p. 5-16
  18. Howland WC (1996) "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy, 26 ( Suppl, p. 18-22
  19. (2001) "Product Information. Flovent (fluticasone)." Glaxo Wellcome
  20. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE (1997) "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol, 43, p. 155-61
  21. McEvoy CE, Niewoehner DE (1997) "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest, 111, p. 732-43
  22. Wiseman LR, Benfield P (1997) "Intranasal fluticasone propionate: A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis." Drugs, 53, p. 885-907
  23. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  24. (2001) "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals
  25. (2001) "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer
  26. (2001) "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer
  27. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR (1999) "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest, 115, p. 1278-84
  28. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R (1999) "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med, 160, p. 157-61
  29. (2008) "Product Information. Alvesco (ciclesonide)." Nycomed USA
  30. (2008) "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc
View all 30 references
Moderate

Inhaled corticosteroids (applies to Breztri Aerosphere) infections

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Infection - Bacterial/Fungal/Protozoal/Viral, Tuberculosis -- Latent

The immunosuppressant and anti-inflammatory effects of corticosteroids, particularly in higher dosages, may decrease host resistance to infectious agents, decrease the ability to localize infections, and mask the symptoms of infection. Secondary infections may be more likely to develop. Therapy with inhaled and nasal corticosteroids should be administered cautiously in patients with an infection, particularly active or quiescent tuberculosis infection of the respiratory tract or any untreated systemic fungal, bacterial, parasitic, or viral infection. Although adverse effects of corticosteroids may be minimized by local rather than systemic administration, the risks are not entirely abolished. Inhaled and nasally applied drug may be absorbed into the circulation, especially when large doses are used. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.

References

  1. Horton DJ, Spector SL (1977) "Clinical pulmonary tuberculosis in an asthmatic patient using a steroid aerosol." Chest, 71, p. 540-2
  2. Carrel TP, Schaffner A, Schmid ER, Schneider J, Bauer EP, Laske A, von Segesser LK, Turina MI (1991) "Fatal fungal pericarditis after cardiac surgery and immunosuppression." J Thorac Cardiovasc Surg, 101, p. 161-4
  3. Vogt FC (1979) "The incidence of oral candidiasis with use of inhaled corticosteroids." Ann Allergy, 43, p. 205-10
  4. Milne LJ, Crompton GK (1974) "Beclomethasone dipropionate and oropharyngeal candidiasis." Br Med J, 3, p. 797-8
  5. Toogood JH, Jennings B, Greenway RW, Chuang L (1980) "Candidiasis and dysphonia complicating beclomethasone treatment of asthma." J Allergy Clin Immunol, 65, p. 145-53
  6. Webb EL (1993) "Nasal candidiasis in a patient on long-term topical intranasal corticosteroid therapy." J Allergy Clin Immunol, 91, p. 680-1
  7. Shaikh WA (1992) "Pulmonary tuberculosis in patients treated with inhaled beclomethasone." Allergy, 47, p. 327-30
  8. Kesten S, Hyland RH, Pruzanski WR, Kortan PP (1988) "Esophageal candidiasis associated with beclomethasone dipropionate aerosol therapy." Drug Intell Clin Pharm, 22, p. 568-9
  9. Brogden RN, Heel RC, Speight TM, Avery GS (1984) "Beclomethasone dipropionate. A reappraisal of its pharmacodynamic properties and therapeutic efficacy after a decade of use in asthma and rhinitis." Drugs, 28, p. 99-126
  10. Messerli C, Studer H, Scherrer M (1975) "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie, 153, p. 29-42
  11. Executive Committee American Academy of Allergy and Immunology (1993) "Inhaled corticosteroids and severe viral infections." J Allergy Clin Immunol, 92, p. 223-8
  12. (2001) "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome
  13. (2001) "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome
  14. (2022) "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals
  15. (2001) "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc
  16. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A (1994) "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol, 38, p. 521-5
  17. Edsbacker S, Andersson KE, Ryrfeldt A (1985) "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol, 29, p. 477-81
  18. (2001) "Product Information. Flonase (fluticasone)." Glaxo Wellcome
  19. (2001) "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals
  20. Howland WC (1996) "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy, 26 ( Suppl, p. 18-22
  21. (2001) "Product Information. Flovent (fluticasone)." Glaxo Wellcome
  22. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE (1997) "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol, 43, p. 155-61
  23. McEvoy CE, Niewoehner DE (1997) "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest, 111, p. 732-43
  24. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  25. (2001) "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals
  26. (2001) "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer
  27. (2001) "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer
  28. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR (1999) "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest, 115, p. 1278-84
  29. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R (1999) "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med, 160, p. 157-61
  30. (2008) "Product Information. Alvesco (ciclesonide)." Nycomed USA
  31. (2008) "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc
View all 31 references
Moderate

Inhaled corticosteroids (applies to Breztri Aerosphere) ocular herpes simplex

Moderate Potential Hazard, Moderate plausibility.

Pharmacologic dosages of corticosteroids may increase the risk of corneal perforation in patients with ocular herpes simplex. Therapy with inhaled and nasal corticosteroids should be administered cautiously in such patients.

References

  1. (2001) "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome
  2. (2001) "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome
  3. (2022) "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals
  4. (2001) "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc
  5. (2001) "Product Information. Flonase (fluticasone)." Glaxo Wellcome
  6. (2001) "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals
  7. (2001) "Product Information. Flovent (fluticasone)." Glaxo Wellcome
  8. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  9. (2001) "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals
  10. (2001) "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer
  11. (2001) "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer
  12. (2008) "Product Information. Alvesco (ciclesonide)." Nycomed USA
  13. (2008) "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc
View all 13 references
Moderate

Inhaled corticosteroids (applies to Breztri Aerosphere) ocular toxicities

Moderate Potential Hazard, Low plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension, Cataracts

Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Therapy with inhaled and nasal corticosteroids has only rarely produced these effects but should be administered cautiously nonetheless in patients with a history of cataracts, glaucoma, or increased intraocular pressure. Although adverse effects of corticosteroids may be minimized by local rather than systemic administration, the risks are not entirely abolished. Inhaled and nasally applied drug may be absorbed into the circulation, especially when large doses are used. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.

References

  1. Fraunfelder FT, Meyer SM (1990) "Posterior subcapsular cataracts associated with nasal or inhalation corticosteroids." Am J Ophthalmol, 109, p. 489-90
  2. Karim AK, Thompson GM, Jacob TJ (1989) "Steroid aerosols and cataract formation." BMJ, 299, p. 918
  3. Allen MB, Ray SG, Leitch AG, Dhillon B, Cullen B (1989) "Steroid aerosols and cataract formation." BMJ, 299, p. 432-3
  4. Kewley GD (1980) "Possible association between beclomethasone diproprionate aerosol and cataracts." Aust Paediatr J, 16, p. 117-8
  5. Messerli C, Studer H, Scherrer M (1975) "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie, 153, p. 29-42
  6. Ghanchi F (1993) "Young patients on inhaled steroids and cataract." Lancet, 342, p. 1306-7
  7. Dreyer EB (1993) "Inhaled steroid use and glaucoma." N Engl J Med, 329, p. 1822
  8. (2001) "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome
  9. (2001) "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome
  10. (2022) "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals
  11. (2001) "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc
  12. Spaeth GL, Rodrigues MM, Weinreb S (1977) "Steroid-induced glaucoma: A. Persistent elevation of intraocular pressure B. Histopathological aspects." Trans Am Ophthalmol Soc, 75, p. 353-81
  13. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A (1994) "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol, 38, p. 521-5
  14. Edsbacker S, Andersson KE, Ryrfeldt A (1985) "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol, 29, p. 477-81
  15. (2001) "Product Information. Flonase (fluticasone)." Glaxo Wellcome
  16. Barnes PJ (1995) "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med, 332, p. 868-75
  17. (2001) "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals
  18. Howland WC (1996) "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy, 26 ( Suppl, p. 18-22
  19. Garbe E, LeLorier J, Boivin JF, Suissa S (1997) "Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma." JAMA, 277, p. 722-7
  20. (2001) "Product Information. Flovent (fluticasone)." Glaxo Wellcome
  21. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE (1997) "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol, 43, p. 155-61
  22. McEvoy CE, Niewoehner DE (1997) "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest, 111, p. 732-43
  23. Cumming RG, Mitchell P, Leeder SR (1997) "Use of inhaled corticosteroids and the risk of cataracts." N Engl J Med, 337, p. 8-14
  24. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  25. (2001) "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals
  26. Agertoft L, Larsen FE, Pedersen S (1998) "Posterior subcapsular cataracts, bruises and hoarseness in children with asthma receiving long-term treatment with inhaled budesonide." Eur Resp J, 12, p. 130-5
  27. (2001) "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer
  28. (2001) "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer
  29. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR (1999) "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest, 115, p. 1278-84
  30. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R (1999) "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med, 160, p. 157-61
  31. (2008) "Product Information. Alvesco (ciclesonide)." Nycomed USA
  32. (2008) "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc
View all 32 references
Moderate

Inhaled corticosteroids (applies to Breztri Aerosphere) osteoporosis

Moderate Potential Hazard, Moderate plausibility.

Prolonged use of inhaled corticosteroids may be associated with a reduction in bone density. This effect appears to be dose-related and has been reported primarily with high dosages (>= 800 mcg/day of beclomethasone or equivalent for >= 1 year). Reduced levels of total body calcium have also been demonstrated in patients receiving lower dosages. Long-term therapy with inhaled and nasal corticosteroids should be administered cautiously in patients with osteoporosis. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.

References

  1. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A (1994) "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol, 38, p. 521-5
  2. Toogood JH, Crilly RG, Jones G, Nadeau J, Wells GA (1988) "Effect of high-dose inhaled budesonide on calcium and phosphate metabolism and the risk of osteoporosis." Am Rev Respir Dis, 138, p. 57-61
  3. Edsbacker S, Andersson KE, Ryrfeldt A (1985) "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol, 29, p. 477-81
  4. Konig P, Hillman L, Cervantes C, Levine C, Maloney C, Douglass B, Johnson L, Allen S (1993) "Bone metabolism in children with asthma treated with inhaled beclomethasone dipropionate." J Pediatr, 122, p. 219-26
  5. Kinberg KA, Hopp RJ, Biven RE, Gallagher JC (1994) "Bone mineral density in normal and asthmatic children." J Allergy Clin Immunol, 94, p. 490-7
  6. Barnes PJ (1995) "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med, 332, p. 868-75
  7. Toogood JH, Baskerville JC, Markov AE, Hodsman AB, Fraher LJ, Jennings B, Haddad RG, Drost D (1995) "Bone mineral density and the risk of fracture in patients receiving long-term inhaled steroid therapy for asthma." J Allergy Clin Immunol, 96, p. 157-66
  8. Hanania NA, Chapman KR, Sturtridge WC, Szalai JP, Kesten S (1995) "Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids." J Allergy Clin Immunol, 96, p. 571-9
  9. Martinati LC, Bertoldo F, Gasperi E, Micelli S, Boner AL (1996) "Effect on cortical and trabecular bone mass of different anti-inflammatory treatments in preadolescent children with chronic asthma." Am J Respir Crit Care Med, 153, p. 232-6
  10. Packe GE, Douglas JG, McDonald AF, Robins SP, Reid DM (1992) "Bone density in asthmatic patients taking high dose inhaled beclomethasone diproprionate and intermittent systemic corticosteroids." Thorax, 47, p. 414-7
  11. Reid DM, Nicoll JJ, Smith MA, Higgins B, Tothill P, Nuki G (1986) "Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica." BMJ, 293, p. 1463-6
  12. Ali NJ, Capewell S, Ward MJ (1991) "Bone turnover during high dose inhaled corticosteroid treatment." Thorax, 46, p. 160-4
  13. Howland WC (1996) "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy, 26 ( Suppl, p. 18-22
  14. Packe GE, Robb O, Robins SP, Reid DM, Douglas JG (1996) "Bone density in asthmatic patients taking inhaled corticosteroids: comparison of budesonide and beclomethasone dipropionate." J R Coll Physicians Lond, 30, p. 128-32
  15. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE (1997) "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol, 43, p. 155-61
  16. McEvoy CE, Niewoehner DE (1997) "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest, 111, p. 732-43
  17. Wiseman LR, Benfield P (1997) "Intranasal fluticasone propionate: A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis." Drugs, 53, p. 885-907
  18. Luengo M, delRio L, Pons F, Picado C (1997) "Bone mineral density in asthmatic patients treated with inhaled corticosteroids: a case-control study." Eur Respir J, 10, p. 2110-3
  19. Wisniewski AF, Lewis SA, Green DJ, Maslanka W, Burrell H, Tattersfield AE (1997) "Cross sectional investigation of the effects of inhaled corticosteroids on bone density and bone metabolism in patients with asthma." Thorax, 52, p. 853-60
  20. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R (1999) "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med, 160, p. 157-61
  21. Wong CA, Walsh LJ, Smith CJP, Wisniewski AF, Lewis SA, Hubbard R, Cawte S, Green DJ, Pringle M, Tattersfield AE (2000) "Inhaled corticosteroid use and bone-mineral density in patients with asthma." Lancet, 355, p. 1399-403
  22. Israel E, Banerjee TR, Fitzmaurice GM, Kotlov TV, LaHive K, LeBoff MS (2001) "Effects of inhaled glucocorticoids on bone density in premenopausal women." N Engl J Med, 345, p. 941-7
  23. Sharma PK, Malhotra S, Pandhi P, Kumar N (2003) "Effect of inhaled steroids on bone mineral density: a meta-analysis." J Clin Pharmacol, 43, p. 193-7
  24. Boulet LP, Milot J, Gagnon L, Poubelle PE, Brown J (1999) "Long-term influence of inhaled corticosteroids on bone metabolism and density. Are biological markers predictors of bone loss?" Am J Respir Crit Care Med, 159, p. 838-44
View all 24 references
Minor

Anticholinergics (applies to Breztri Aerosphere) hypertension

Minor Potential Hazard, Moderate plausibility.

Cardiovascular effects of anticholinergics may exacerbate hypertension. Therapy with anticholinergic agents should be administered cautiously in patients with hypertension.

References

  1. (2002) "Product Information. Benadryl (diphenhydramine)." Parke-Davis
  2. (2001) "Product Information. Antivert (meclizine)." Roerig Division
  3. (2001) "Product Information. Marezine (cyclizine)." Glaxo Wellcome
  4. Valentin N, Staffeldt H, Kyst A (1984) "Effect of i.v. atropine on cardiac rhythm, heart rate, blood pressure and airway secretion during isoflurane anaesthesia." Acta Anaesthesiol Scand, 28, p. 621-4
  5. (2022) "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics
  6. (2001) "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories
  7. (2002) "Product Information. Atropisol (atropine ophthalmic)." Ciba Vision Ophthalmics
View all 7 references
Minor

Atropine-like agents (applies to Breztri Aerosphere) fever

Minor Potential Hazard, Moderate plausibility.

Atropine-like agents may increase the risk of hyperthermia in patients with fever by producing anhidrosis. Therapy with atropine-like agents should be administered cautiously in febrile patients.

References

  1. Stadnyk AN, Glezos JD (1983) "Drug-induced heat stroke." Can Med Assoc J, 128, p. 957-9
  2. Sarnquist F, Larson CP Jr (1973) "Drug-induced heat stroke." Anesthesiology, 39, p. 348-50
  3. Lee BS (1986) "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry, 47, p. 571
  4. Forester D (1978) "Fatal drug-induced heat stroke." JACEP, 7, p. 243-4
  5. (2022) "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics
  6. (2001) "Product Information. Cogentin (benztropine)." Merck & Co., Inc
View all 6 references

Breztri Aerosphere drug interactions

There are 913 drug interactions with Breztri Aerosphere (budesonide / formoterol / glycopyrrolate).

Breztri Aerosphere alcohol/food interactions

There are 5 alcohol/food interactions with Breztri Aerosphere (budesonide / formoterol / glycopyrrolate).


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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.