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Breztri Aerosphere Disease Interactions

There are 22 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 "Bradycardia due to trihexyphenidyl hydrochloride." Drug Intell Clin Pharm 20 (1986): 786-7
  2. Voinov H, Elefante V, Mujica R "Sinus bradycardia related to the use of benztropine mesylate." Am J Psychiatry 149 (1992): 711
  3. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
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. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
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 "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  2. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  3. Blamoutier J "Comparative trial of two antihistamines, mequitazine and brompheniramine." Curr Med Res Opin 5 (1978): 366-70
  4. "Azatadine (optimine)--a new antihistamine." Med Lett Drugs Ther 19 (1977): 77-9
  5. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  6. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  7. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  8. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  9. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  11. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  12. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  13. Mevorach D "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother 26 (1992): 564
  14. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  15. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  16. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
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 "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  3. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  4. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  5. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  6. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  7. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  8. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  9. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  10. O'Connor PS, Mumma JV "Atropine toxicity." Am J Ophthalmol 99 (1985): 613-4
  11. Clearkin LG "Angle closure glaucoma precipitated by atropine." Arch Intern Med 152 (1992): 880
  12. Berdy GJ, Berdy SS, Odin LS, Hirst LW "Angle closure glaucoma precipitated by aerosolized atropine." Arch Intern Med 151 (1991): 1658-60
  13. Pecora JL "Malignant glaucoma worsened by miotics in a postoperative angle- closure glaucoma patient." Ann Ophthalmol 11 (1979): 1412-4
  14. Holland MG "Autonomic drugs in ophthalmology: some problems and promises. Section II: Anticholinergic drugs." Ann Ophthalmol 6 (1974): 661-4
  15. Kanto J "New aspects in the use of atropine." Int J Clin Pharmacol Ther Toxicol 21 (1983): 92-4
  16. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  17. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  18. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34
  19. "Product Information. Cogentin (benztropine)." Merck & Company Inc (2001):
  20. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  21. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  22. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  23. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
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 "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  2. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  3. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Chlor-Trimeton (chlorpheniramine)." Schering-Plough
  5. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham (2002):
  6. "Product Information. Periactin (cyproheptadine)." Merck & Company Inc (2002):
  7. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  8. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation (2001):
  10. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  11. "Product Information. Optimine (azatadine)." Schering Corporation (2001):
  12. Shutt LE, Bowes JB "Atropine and hyoscine." Anaesthesia 34 (1979): 476-90
  13. O'Kelly SW, Spargo PM "Postoperative urinary retention in men." BMJ 302 (1991): 1403-4
  14. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  15. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham (2001):
  16. "Product Information. Zyrtec (cetirizine)." Pfizer U.S. Pharmaceuticals (2001):
  17. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  18. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  19. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  20. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmacal Company (2001):
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 "Dyskinesias after antihistamine use ." N Engl J Med 296 (1977): 111
  2. Jones B, Lal S "Tardive dyskinesia uncovered after ingestion of Sominex, an over-the- counter drug." Can J Psychiatry 30 (1985): 370-1
  3. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  4. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  5. Burnett GB, Prange AJ Jr, Wilson IC, Jolliff LA, Creese IC, Synder SH "Adverse effects of anticholinergic antiparkinsonian drugs in tardive dyskinesia. An investigation of mechanism." Neuropsychobiology 6 (1980): 109-20
  6. Kiloh LG, Smith JS, Williams SE "Antiparkinson drugs as causal agents in tardive dykinesia." Med J Aust 2 (1973): 591-3
  7. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
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 "Toxic megacolon associated with loperamide therapy." JAMA 241 (1979): 501-2
  2. Walley T, Milson D "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J 66 (1990): 582
  3. "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals (2001):
  4. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4
  5. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
  6. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
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. "Product Information. Cuvposa (glycopyrrolate)." Shionogi USA Inc (2010):
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 "Adverse effects of antiparkinson drug withdrawal." Am J Psychiatry 138 (1981): 1567-71
  2. Goggin DA, Solomon GF "Trihexyphenidyl abuse for euphorigenic effect." Am J Psychiatry 136 (1979): 459-60
  3. Macvicar K "Abuse of antiparkinsonian drugs by psychiatric patients." Am J Psychiatry 134 (1977): 809-11
  4. Craig DH, Rosen P "Abuse of antiparkinsonian drugs." Ann Emerg Med 10 (1981): 98-100
  5. Pullen GP, Best NR, Maguire J "Anticholinergic drug abuse: a common problem?" Br Med J (Clin Res Ed) 289 (1984): 612-3
  6. Rubinstein JS "Abuse of antiparkinsonism drugs. Feigning of extrapyramidal symptoms to obtain trihexyphenidyl." JAMA 239 (1978): 2365-6
  7. McInnis M, Petursson H "Trihexyphenidyl dependence." Acta Psychiatr Scand 69 (1984): 538-42
  8. Mohan D, Mohandas E, Dube S "Trihexyphenidyl abuse." Br J Addict 76 (1981): 195-7
  9. Kaminer Y, Munitz H, Wijsenbeek H "Trihexyphenidyl (Artane) abuse: euphoriant and anxiolytic." Br J Psychiatry 140 (1982): 473-4
  10. Warnes H "Toxic psychosis due to antiparkinsonian drugs." Can Psychiatr Assoc J 12 (1967): 323-6
  11. Hidalgo HA, Mowers RM "Anticholinergic drug abuse." DICP 24 (1990): 40-1
  12. Wilcox JA "Psychoactive properties of benztropine and trihexyphenidyl." J Psychoactive Drugs 15 (1983): 319-21
  13. Laski E, Taleporos E "Anticholinergic psychosis in a bilingual: a case study." Am J Psychiatry 134 (1977): 1038-40
  14. Brower KJ "Smoking of prescription anticholinergic drugs." Am J Psychiatry 144 (1987): 383
  15. Baker LA, Cheng LY, Amara IB "The withdrawal of benztropine mesylate in chronic schizophrenic patients." Br J Psychiatry 143 (1983): 584-90
  16. Moreau A, Jones BD, Banno V "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry 31 (1986): 339-41
  17. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  18. Ananth JV, Jain RC "Benztropine psychosis." Can Psychiatr Assoc J 18 (1973): 409-14
  19. Woody GE, O'Brien CP "Anticholinergic toxic psychosis in drug abusers treated with benztropine." Compr Psychiatry 15 (1974): 439-42
  20. "Product Information. Cogentin (benztropine)." Merck & Company Inc (2001):
  21. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82
  22. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
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 "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol 26 (1988): 385-7
  2. Larsson S "Long-term treatment with beta2-adrenostimulants in asthma. Side effects, selectivity, tolerance, and routes of administration." Acta Med Scand Suppl 608 (1977): 1-40
  3. Mettauer B, Rouleau JL, Burgess JH "Detrimental arrhythmogenic and sustained beneficial hemodynamic effects of oral salbutamol in patients with chronic congestive heart failure." Am Heart J 109 (1985): 840-7
  4. Larsson S, Svedmyr N "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 (1977): 861-9
  5. Vathenen AS, Britton JR, Ebden P, Cookson JB, Wharrad HJ, Tattersfield AE "High-dose inhaled albuterol in severe chronic airflow limitation." Am Rev Respir Dis 138 (1988): 850-5
  6. Godfrey S "Worldwide experience with albuterol (salbutamol)." Ann Allergy 47 (1981): 423-6
  7. Finch JS "Cardiovascular toxicity: clinical evaluation of albuterol, isoproterenol and placebo in rising dose tolerance trial." Ann Allergy 47 (1981): 402-4
  8. Neville E, Corris PA, Vivian J, Nariman S, Gibson GJ "Nebulised salbutamol and angina." Br Med J (Clin Res Ed) 285 (1982): 796-7
  9. Breeden CC, Safirstein BH "Albuterol and spacer-induced atrial fibrillation." Chest 98 (1990): 762-3
  10. Wolfe JD, Yamate M, Biedermann AA, Chu TJ "Comparison of the acute cardiopulmonary effects of oral albuterol, metaproterenol, and terbutaline in asthmatics." JAMA 253 (1985): 2068-72
  11. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
  12. Shovlin CL, Tam FW "Salbutamol nebuliser and precipitation of critical cardiac ischaemia." Lancet 336 (1990): 1258
  13. Spitzer WO, Suissa S, Ernst P, Horwitz RI, Habbick B, Cockcroft D, Boivin JF, McNutt M, Buist AS, Rebuck AS "The use of beta-agonists and the risk of death and near death from asthma." N Engl J Med 326 (1992): 501-6
  14. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  15. Richards DM, Brogden RN "Pirbuterol. A preliminary review of its pharmacological properties and therapeutic efficacy in reversible bronchospastic disease." Drugs 30 (1985): 6-21
  16. Lampert MB, Hibbard J, Weinert L, Briller J, Lindheimer M, Lang RM "Peripartum heart failure associated with prolonged tocolytic therapy." Am J Obstet Gynecol 168 (1993): 493-5
  17. Al-Hillawi AH, Hayward R, Johnson NM "Incidence of cardiac arrhythmias in patients taking slow release salbutamol and slow release terbutaline for asthma." Br Med J (Clin Res Ed) 288 (1984): 367
  18. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  19. "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 (1985): 443-9
  20. Wagner JM, Morton MJ, Johnson KA, O'Grady JP, Speroff L "Terbutaline and maternal cardiac function." JAMA 246 (1981): 2697-701
  21. Kinney EL, Trautlein JJ, Harbaugh CV, Lambert D, Zelis RF "Ventricular tachycardia after terbutaline." JAMA 240 (1978): 2247
  22. Whitsett TL, Manion CV, Wilson MF "Cardiac, pulmonary and neuromuscular effects of clenbuterol and terbutaline compared with placebo." Br J Clin Pharmacol 12 (1981): 195-200
  23. Brogden RN, Speight TM, Avery GS "Terbutaline: a preliminary report of its pharmacological properties and therapeutic efficacy in asthma." Drugs 6 (1973): 324-32
  24. Trautlein J, Allegra J, Gillin M "Aerosolized terbutaline sulfate--an evalution of efficacy and side effects in patients with reversible airway disease." J Clin Pharmacol 17 (1977): 76-80
  25. Maguire GP, Emirgil C "Bronchodilator and side effects of different modes of administration of metaproterenol: inhaled, oral, and in combination." Am J Med Sci 291 (1986): 168-74
  26. Ence TJ, Tashkin DP, Ho D, Child JS "Acute bronchial and cardiovascular effects of oral pirbuterol and metaproterenol." Ann Allergy 43 (1979): 229-36
  27. Sanders JP, Potter DE, Ellis S, Bee DE, Grant JA "Metabolic and cardiovascular effects of carbuterol and metaproterenol." J Allergy Clin Immunol 60 (1977): 174-9
  28. "Product Information. Proventil (albuterol)." Schering Corporation (2002):
  29. "Product Information. Ventolin (albuterol)." Glaxo Wellcome (2002):
  30. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals (2001):
  31. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  32. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  33. Brogden RN, Faulds D "Salmeterol xinafoate. A review of its pharmacological properties and therapeutic potential in reversible obstructive airways disease." Drugs 42 (1991): 895-912
  34. Littner MR, Tashkin DP, Calvarese B, Bautista M "Acute bronchial and cardiovascular effects of increasing doses of pirbuterol acetate aerosol in asthma." Ann Allergy 48 (1982): 14-20
  35. Chodosh S, Crooks LA, Tuck J "Comparative effects of pirbuterol acetate, metaproterenol, and placebo aerosols on pulmonary function and incidence of cardiac ectopy." J Asthma 26 (1989): 309-15
  36. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  37. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals (2001):
  38. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim (2001):
  39. Hibbard JU "Chronic terbutaline therapy and peripartum cardiomyopathy: a case-control study." Hypertens Pregnancy 15 (1996): 183-91
  40. Katz M, Robertson PA, Creasy RK "Cardiovascular complications associated with terbutaline treatment for preterm labor." Am J Obstet Gynecol 139 (1981): 605-8
  41. Suissa S, Hemmelgarn B, Blais L, Ernst P "Bronchodilators and acute cardiac death." Am J Respir Crit Care Med 154 (1996): 1598-602
  42. Tranfa CME, Pelaia G, Grembiale RD, Naty S, Durante S, Borrello G "Short-term cardiovascular effects of salmeterol." Chest 113 (1998): 1272-6
  43. Braden GL, Germain MJ, Mulhern JG, Hafer JG, Bria WF "Hemodynamic, cardiac, and electrolyte effects of low-dose aerosolized terbutaline sulfate in asthmatic patients." Chest 114 (1998): 380-7
  44. Jenne JW "Can oral beta(2) agonists cause heart failure?" Lancet 352 (1998): 1081-2
  45. "Product Information. Tornalate (bitolterol)." Apothecon Inc (2022):
  46. Nathan RA, Bronsky EA, Dockhorn RJ, Kemp JP "Multicenter dose-ranging study of bitolterol mesylate solution for nebulization in children with asthma." Ann Allergy 72 (1994): 209-16
  47. Bierman CW, Kemp JP, Nathan RA "Efficacy and safety of inhaled bitolterol mesylate via metered-dose inhaler in children with asthma." Ann Allergy Asthma Immunol 76 (1996): 27-35
  48. Pinnas JL, Bhatt BD, Campbell SC, Kemp JP, Tinkelman DG "Dose-response study of nebulized bitolterol mesylate solution in asthmatic patients." Chest 91 (1987): 533-9
  49. "Product Information. Xopenex (levalbuterol)." Sepracor Inc (2001):
  50. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS "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 (1999): 615-21
  51. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
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 "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol 26 (1988): 385-7
  2. Hastwell G, Lambert BE "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol 85 (1978): 767-9
  3. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  4. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  5. "Product Information. Proventil (albuterol)." Schering Corporation (2002):
  6. "Product Information. Ventolin (albuterol)." Glaxo Wellcome (2002):
  7. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals (2001):
  8. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  9. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  10. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  11. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals (2001):
  12. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim (2001):
  13. "Product Information. Tornalate (bitolterol)." Apothecon Inc (2022):
  14. "Product Information. Xopenex (levalbuterol)." Sepracor Inc (2001):
  15. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS "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 (1999): 615-21
  16. "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals (2001):
  17. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
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 "The mechanism of salbutamol-induced hypokalaemia." Br J Clin Pharmacol 23 (1987): 65-71
  2. Larsson S, Svedmyr N "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 (1977): 861-9
  3. Allon M, Dunlay R, Copkney C "Nebulized albuterol for acute hyperkalemia in patients on hemodialysis." Ann Intern Med 110 (1989): 426-9
  4. Hastwell G, Lambert BE "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol 85 (1978): 767-9
  5. "Hypokalaemia due to salbutamol overdosage." Br Med J (Clin Res Ed) 283 (1981): 500-1
  6. Kantola I, Tarssanen L "Hypokalemia from usual salbutamol dosage ." Chest 89 (1986): 619-20
  7. Montoliu J, Almirall J, Ponz E, Campistol JM, Revert L "Treatment of hyperkalaemia in renal failure with salbutamol inhalation." J Intern Med 228 (1990): 35-7
  8. Wong CS, Pavord ID, Williams J, Britton JR, Tattersfield AE "Bronchodilator, cardiovascular, and hypokalaemic effects of fenoterol, salbutamol, and terbutaline in asthma." Lancet 336 (1990): 1396-9
  9. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  10. Gross TL, Sokol RJ "Severe hypokalemia and acidosis: a potential complication of beta- adrenergic treatment." Am J Obstet Gynecol 138 (1980): 1225-6
  11. Hurlbert BJ, Edelman JD, David K "Serum potassium levels during and after terbutaline." Anesth Analg 60 (1981): 723-5
  12. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  13. Gelmont DM, Balmes JR, Yee A "Hypokalemia induced by inhaled bronchodilators." Chest 94 (1988): 763-6
  14. Sanders JP, Potter DE, Ellis S, Bee DE, Grant JA "Metabolic and cardiovascular effects of carbuterol and metaproterenol." J Allergy Clin Immunol 60 (1977): 174-9
  15. "Product Information. Proventil (albuterol)." Schering Corporation (2002):
  16. "Product Information. Ventolin (albuterol)." Glaxo Wellcome (2002):
  17. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals (2001):
  18. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  19. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  20. Windom H, Grainger J, Burgess C, Crane J, Pearce N, Beasley R "A comparison of the haemodynamic and hypokalaemic effects of inhaled pirbuterol and salbutamol." N Z Med J 103 (1990): 259-61
  21. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  22. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals (2001):
  23. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K "Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta(2)-adrenergic stimulation with terbutaline in healthy subjects." Chest 106 (1994): 1654-9
  24. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim (2001):
  25. Braden GL, vonOeyen PT, Germain MJ, Watson DJ, Haag BL "Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences." Kidney Int 51 (1997): 1867-75
  26. Rakhmanina NY, Kearns GL, Farrar HC "Hypokalemia in an asthmatic child from abuse of albuterol metered dose inhaler." Pediatr Emerg Care 14 (1998): 145-7
  27. "Product Information. Tornalate (bitolterol)." Apothecon Inc (2022):
  28. "Product Information. Xopenex (levalbuterol)." Sepracor Inc (2001):
  29. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS "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 (1999): 615-21
  30. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
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 "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 (1977): 861-9
  2. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  3. "Product Information. Proventil (albuterol)." Schering Corporation (2002):
  4. "Product Information. Ventolin (albuterol)." Glaxo Wellcome (2002):
  5. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals (2001):
  6. "Product Information. Serevent (salmeterol)." Glaxo Wellcome
  7. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals (2001):
  8. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim (2001):
  9. "Product Information. Tornalate (bitolterol)." Apothecon Inc (2022):
  10. "Product Information. Xopenex (levalbuterol)." Sepracor Inc (2001):
  11. "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals (2001):
  12. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
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

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. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
  2. "Product Information. Asmanex Twisthaler (mometasone)." Schering-Plough Corporation (2005):
  3. "Product Information. Beconase AQ (beclomethasone nasal)." GlaxoSmithKline (2015):
  4. "Product Information. Pulmicort Flexhaler (budesonide)." A-S Medication Solutions (2016):
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 "Iatrogenic Cushing's syndrome due to dexamethasone nasal drops." Am J Med 79 (1985): 535-7
  2. Monk B, Cunliffe WJ, Layton AM, Rhodes DJ "Acne induced by inhaled corticosteroids." Clin Exp Dermatol 18 (1993): 148-50
  3. Brogden RN, Heel RC, Speight TM, Avery GS "Beclomethasone dipropionate. A reappraisal of its pharmacodynamic properties and therapeutic efficacy after a decade of use in asthma and rhinitis." Drugs 28 (1984): 99-126
  4. Clark TJ "Safety of inhaled corticosteroids." Eur J Respir Dis Suppl 122 (1982): 235-42
  5. Messerli C, Studer H, Scherrer M "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie 153 (1975): 29-42
  6. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
  7. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
  8. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
  9. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
  10. van As A, Bronsky E, Grossman J, Meltzer E, Ratner P, Reed C "Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis." Ann Allergy 67 (1991): 156-62
  11. Stevens DJ "Cushing's syndrome due to the abuse of betamethasone nasal drops." J Laryngol Otol 102 (1988): 219-21
  12. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
  13. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
  14. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
  15. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
  16. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  17. Robinson DS, Geddes DM "Inhaled corticosteroids: benefits and risks." J Asthma 33 (1996): 5-16
  18. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  19. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
  20. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
  21. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  22. Wiseman LR, Benfield P "Intranasal fluticasone propionate: A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis." Drugs 53 (1997): 885-907
  23. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  24. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  25. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
  26. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
  27. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest 115 (1999): 1278-84
  28. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
  29. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
  30. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
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 "Clinical pulmonary tuberculosis in an asthmatic patient using a steroid aerosol." Chest 71 (1977): 540-2
  2. Carrel TP, Schaffner A, Schmid ER, Schneider J, Bauer EP, Laske A, von Segesser LK, Turina MI "Fatal fungal pericarditis after cardiac surgery and immunosuppression." J Thorac Cardiovasc Surg 101 (1991): 161-4
  3. Vogt FC "The incidence of oral candidiasis with use of inhaled corticosteroids." Ann Allergy 43 (1979): 205-10
  4. Milne LJ, Crompton GK "Beclomethasone dipropionate and oropharyngeal candidiasis." Br Med J 3 (1974): 797-8
  5. Toogood JH, Jennings B, Greenway RW, Chuang L "Candidiasis and dysphonia complicating beclomethasone treatment of asthma." J Allergy Clin Immunol 65 (1980): 145-53
  6. Webb EL "Nasal candidiasis in a patient on long-term topical intranasal corticosteroid therapy." J Allergy Clin Immunol 91 (1993): 680-1
  7. Shaikh WA "Pulmonary tuberculosis in patients treated with inhaled beclomethasone." Allergy 47 (1992): 327-30
  8. Kesten S, Hyland RH, Pruzanski WR, Kortan PP "Esophageal candidiasis associated with beclomethasone dipropionate aerosol therapy." Drug Intell Clin Pharm 22 (1988): 568-9
  9. Brogden RN, Heel RC, Speight TM, Avery GS "Beclomethasone dipropionate. A reappraisal of its pharmacodynamic properties and therapeutic efficacy after a decade of use in asthma and rhinitis." Drugs 28 (1984): 99-126
  10. Messerli C, Studer H, Scherrer M "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie 153 (1975): 29-42
  11. Executive Committee American Academy of Allergy and Immunology "Inhaled corticosteroids and severe viral infections." J Allergy Clin Immunol 92 (1993): 223-8
  12. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
  13. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
  14. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
  15. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
  16. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
  17. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
  18. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
  19. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  20. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  21. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
  22. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
  23. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  24. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  25. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  26. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
  27. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
  28. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest 115 (1999): 1278-84
  29. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
  30. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
  31. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
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. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
  2. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
  3. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
  4. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
  5. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
  6. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  7. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
  8. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  9. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  10. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
  11. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
  12. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
  13. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
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 "Posterior subcapsular cataracts associated with nasal or inhalation corticosteroids." Am J Ophthalmol 109 (1990): 489-90
  2. Karim AK, Thompson GM, Jacob TJ "Steroid aerosols and cataract formation." BMJ 299 (1989): 918
  3. Allen MB, Ray SG, Leitch AG, Dhillon B, Cullen B "Steroid aerosols and cataract formation." BMJ 299 (1989): 432-3
  4. Kewley GD "Possible association between beclomethasone diproprionate aerosol and cataracts." Aust Paediatr J 16 (1980): 117-8
  5. Messerli C, Studer H, Scherrer M "Systemic side effects of beclomethasone dipropionate aerosols (becotide, aldecine, sanasthmyl) in otherwise non steroid treated asthmatic patients." Pneumonologie 153 (1975): 29-42
  6. Ghanchi F "Young patients on inhaled steroids and cataract." Lancet 342 (1993): 1306-7
  7. Dreyer EB "Inhaled steroid use and glaucoma." N Engl J Med 329 (1993): 1822
  8. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome (2001):
  9. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome (2001):
  10. "Product Information. AeroBid (flunisolide)." Forest Pharmaceuticals (2022):
  11. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc (2001):
  12. Spaeth GL, Rodrigues MM, Weinreb S "Steroid-induced glaucoma: A. Persistent elevation of intraocular pressure B. Histopathological aspects." Trans Am Ophthalmol Soc 75 (1977): 353-81
  13. Grahnen A, Eckernas SA, Brundin RM, Lingandersson A "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
  14. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
  15. "Product Information. Flonase (fluticasone)." Glaxo Wellcome (2001):
  16. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
  17. "Product Information. Rhinocort (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  18. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  19. Garbe E, LeLorier J, Boivin JF, Suissa S "Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma." JAMA 277 (1997): 722-7
  20. "Product Information. Flovent (fluticasone)." Glaxo Wellcome (2001):
  21. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
  22. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  23. Cumming RG, Mitchell P, Leeder SR "Use of inhaled corticosteroids and the risk of cataracts." N Engl J Med 337 (1997): 8-14
  24. "Product Information. Nasonex (mometasone nasal)." Scherer Laboratories Inc
  25. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra-Zeneca Pharmaceuticals (2001):
  26. Agertoft L, Larsen FE, Pedersen S "Posterior subcapsular cataracts, bruises and hoarseness in children with asthma receiving long-term treatment with inhaled budesonide." Eur Resp J 12 (1998): 130-5
  27. "Product Information. Azmacort (triamcinolone)." Rhone Poulenc Rorer (2001):
  28. "Product Information. Nasacort (triamcinolone nasal)." Rhone Poulenc Rorer (2001):
  29. Wales D, Makker H, Kane J, McDowell P, ODriscoll BR "Systemic bioavailability and potency of high-dose inhaled corticosteroids - A comparison of four inhaler devices and three drugs in healthy adult volunteers." Chest 115 (1999): 1278-84
  30. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
  31. "Product Information. Alvesco (ciclesonide)." Nycomed USA (2008):
  32. "Product Information. Omnaris (ciclesonide nasal)." Sepracor Inc (2008):
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 "An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers." Br J Clin Pharmacol 38 (1994): 521-5
  2. Toogood JH, Crilly RG, Jones G, Nadeau J, Wells GA "Effect of high-dose inhaled budesonide on calcium and phosphate metabolism and the risk of osteoporosis." Am Rev Respir Dis 138 (1988): 57-61
  3. Edsbacker S, Andersson KE, Ryrfeldt A "Nasal bioavailability and systemic effects of the glucocorticoid budesonide in man." Eur J Clin Pharmacol 29 (1985): 477-81
  4. Konig P, Hillman L, Cervantes C, Levine C, Maloney C, Douglass B, Johnson L, Allen S "Bone metabolism in children with asthma treated with inhaled beclomethasone dipropionate." J Pediatr 122 (1993): 219-26
  5. Kinberg KA, Hopp RJ, Biven RE, Gallagher JC "Bone mineral density in normal and asthmatic children." J Allergy Clin Immunol 94 (1994): 490-7
  6. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
  7. Toogood JH, Baskerville JC, Markov AE, Hodsman AB, Fraher LJ, Jennings B, Haddad RG, Drost D "Bone mineral density and the risk of fracture in patients receiving long-term inhaled steroid therapy for asthma." J Allergy Clin Immunol 96 (1995): 157-66
  8. Hanania NA, Chapman KR, Sturtridge WC, Szalai JP, Kesten S "Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids." J Allergy Clin Immunol 96 (1995): 571-9
  9. Martinati LC, Bertoldo F, Gasperi E, Micelli S, Boner AL "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 (1996): 232-6
  10. Packe GE, Douglas JG, McDonald AF, Robins SP, Reid DM "Bone density in asthmatic patients taking high dose inhaled beclomethasone diproprionate and intermittent systemic corticosteroids." Thorax 47 (1992): 414-7
  11. Reid DM, Nicoll JJ, Smith MA, Higgins B, Tothill P, Nuki G "Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica." BMJ 293 (1986): 1463-6
  12. Ali NJ, Capewell S, Ward MJ "Bone turnover during high dose inhaled corticosteroid treatment." Thorax 46 (1991): 160-4
  13. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  14. Packe GE, Robb O, Robins SP, Reid DM, Douglas JG "Bone density in asthmatic patients taking inhaled corticosteroids: comparison of budesonide and beclomethasone dipropionate." J R Coll Physicians Lond 30 (1996): 128-32
  15. Thorsson L, Dahlstrom K, Edsbacker S, Kallen A, Paulson J, Wiren JE "Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects." Br J Clin Pharmacol 43 (1997): 155-61
  16. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  17. Wiseman LR, Benfield P "Intranasal fluticasone propionate: A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis." Drugs 53 (1997): 885-907
  18. Luengo M, delRio L, Pons F, Picado C "Bone mineral density in asthmatic patients treated with inhaled corticosteroids: a case-control study." Eur Respir J 10 (1997): 2110-3
  19. Wisniewski AF, Lewis SA, Green DJ, Maslanka W, Burrell H, Tattersfield AE "Cross sectional investigation of the effects of inhaled corticosteroids on bone density and bone metabolism in patients with asthma." Thorax 52 (1997): 853-60
  20. Derom E, Schoor JV, Verhaeghe W, Vincken W, Pauwels R "Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma." Am J Respir Crit Care Med 160 (1999): 157-61
  21. Wong CA, Walsh LJ, Smith CJP, Wisniewski AF, Lewis SA, Hubbard R, Cawte S, Green DJ, Pringle M, Tattersfield AE "Inhaled corticosteroid use and bone-mineral density in patients with asthma." Lancet 355 (2000): 1399-403
  22. Israel E, Banerjee TR, Fitzmaurice GM, Kotlov TV, LaHive K, LeBoff MS "Effects of inhaled glucocorticoids on bone density in premenopausal women." N Engl J Med 345 (2001): 941-7
  23. Sharma PK, Malhotra S, Pandhi P, Kumar N "Effect of inhaled steroids on bone mineral density: a meta-analysis." J Clin Pharmacol 43 (2003): 193-7
  24. Boulet LP, Milot J, Gagnon L, Poubelle PE, Brown J "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 (1999): 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. "Product Information. Benadryl (diphenhydramine)." Parke-Davis (2002):
  2. "Product Information. Antivert (meclizine)." Roerig Division (2001):
  3. "Product Information. Marezine (cyclizine)." Glaxo Wellcome (2001):
  4. Valentin N, Staffeldt H, Kyst A "Effect of i.v. atropine on cardiac rhythm, heart rate, blood pressure and airway secretion during isoflurane anaesthesia." Acta Anaesthesiol Scand 28 (1984): 621-4
  5. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  6. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories (2001):
  7. "Product Information. Atropisol (atropine ophthalmic)." Ciba Vision Ophthalmics (2002):
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 "Drug-induced heat stroke." Can Med Assoc J 128 (1983): 957-9
  2. Sarnquist F, Larson CP Jr "Drug-induced heat stroke." Anesthesiology 39 (1973): 348-50
  3. Lee BS "Possibility of hyperpyrexia with antipsychotic and anticholinergic drugs." J Clin Psychiatry 47 (1986): 571
  4. Forester D "Fatal drug-induced heat stroke." JACEP 7 (1978): 243-4
  5. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):
  6. "Product Information. Cogentin (benztropine)." Merck & Company Inc (2001):
View all 6 references

Breztri Aerosphere drug interactions

There are 870 drug interactions with Breztri Aerosphere (budesonide / formoterol / glycopyrrolate).

Breztri Aerosphere alcohol/food interactions

There are 4 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.