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Budesonide / formoterol / glycopyrrolate Disease Interactions

There are 22 disease interactions with budesonide / formoterol / glycopyrrolate:

Major

Anticholinergics (applies to budesonide/formoterol/glycopyrrolate) 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. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  2. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  3. Blumensohn R, Razoni G, Shalev A, Munitz H "Bradycardia due to trihexyphenidyl hydrochloride." Drug Intell Clin Pharm 20 (1986): 786-7
  4. Voinov H, Elefante V, Mujica R "Sinus bradycardia related to the use of benztropine mesylate." Am J Psychiatry 149 (1992): 711
View all 4 references
Major

Anticholinergics (applies to budesonide/formoterol/glycopyrrolate) 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 Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
Major

Anticholinergics (applies to budesonide/formoterol/glycopyrrolate) 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. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  2. "Azatadine (optimine)--a new antihistamine." Med Lett Drugs Ther 19 (1977): 77-9
  3. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  4. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  5. Blamoutier J "Comparative trial of two antihistamines, mequitazine and brompheniramine." Curr Med Res Opin 5 (1978): 366-70
  6. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  7. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  10. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  11. Simons FE, Frith EM, Simons KJ "The pharmacokinetics and antihistaminic effects of brompheniramine." J Allergy Clin Immunol 70 (1982): 458-64
  12. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  13. Mevorach D "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother 26 (1992): 564
  14. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  15. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  16. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  17. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 17 references
Major

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

Anticholinergics (applies to budesonide/formoterol/glycopyrrolate) 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. Schuller DE, Turkewitz D "Adverse effects of antihistamines." Postgrad Med 79 (1986): 75-86
  2. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  3. "Product Information. Phenergan (promethazine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Poly-Histine-D (pyrilamine)." Bock Pharmaceutical Company, St. Louis, MO.
  5. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  6. Shutt LE, Bowes JB "Atropine and hyoscine." Anaesthesia 34 (1979): 476-90
  7. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  8. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
  9. "Product Information. Optimine (azatadine)." Schering Laboratories, Kenilworth, NJ.
  10. "Product Information. Periactin (cyproheptadine)." Merck & Co, Inc, West Point, PA.
  11. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  12. "Product Information. Zyrtec (cetirizine)." Pfizer US Pharmaceuticals, New York, NY.
  13. "Product Information. Tavist (clemastine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  15. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
  16. O'Kelly SW, Spargo PM "Postoperative urinary retention in men." BMJ 302 (1991): 1403-4
  17. "Product Information. Dimetane (brompheniramine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  18. "Product Information. Chlortrimeton (chlorpheniramine)." Schering-Plough, Liberty Corner, NJ.
  19. Bantz EW, Dolen WK, Chadwick EW, Nelson HS "Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance." Ann Allergy 59 (1987): 341-6
  20. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  21. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
View all 21 references
Major

Anticholinergics (applies to budesonide/formoterol/glycopyrrolate) 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. Jones B, Lal S "Tardive dyskinesia uncovered after ingestion of Sominex, an over-the- counter drug." Can J Psychiatry 30 (1985): 370-1
  2. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  3. 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
  4. Brait KA, Zagerman AJ "Dyskinesias after antihistamine use ." N Engl J Med 296 (1977): 111
  5. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  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, Wayne, NJ.
  8. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
View all 8 references
Major

Antiperistaltic agents (applies to budesonide/formoterol/glycopyrrolate) 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. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  2. "Product Information. Imodium (loperamide)." Janssen Pharmaceutica, Titusville, NJ.
  3. Walley T, Milson D "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J 66 (1990): 582
  4. Brown JW "Toxic megacolon associated with loperamide therapy." JAMA 241 (1979): 501-2
  5. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
  6. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4
View all 6 references
Major

Glycopyrrolate (applies to budesonide/formoterol/glycopyrrolate) myasthenia gravis

Major Potential Hazard, Moderate plausibility.

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

Moderate

Antimuscarinics (applies to budesonide/formoterol/glycopyrrolate) 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. McInnis M, Petursson H "Trihexyphenidyl dependence." Acta Psychiatr Scand 69 (1984): 538-42
  3. Baker LA, Cheng LY, Amara IB "The withdrawal of benztropine mesylate in chronic schizophrenic patients." Br J Psychiatry 143 (1983): 584-90
  4. Kaminer Y, Munitz H, Wijsenbeek H "Trihexyphenidyl (Artane) abuse: euphoriant and anxiolytic." Br J Psychiatry 140 (1982): 473-4
  5. Goggin DA, Solomon GF "Trihexyphenidyl abuse for euphorigenic effect." Am J Psychiatry 136 (1979): 459-60
  6. Yassa R "Antiparkinsonian medication withdrawal in the treatment of tardive dyskinesia: a report of three cases." Can J Psychiatry 30 (1985): 440-2
  7. Woody GE, O'Brien CP "Anticholinergic toxic psychosis in drug abusers treated with benztropine." Compr Psychiatry 15 (1974): 439-42
  8. Kulik AV, Wilbur R "Delirium and stereotypy from anticholinergic antiparkinson drugs." Prog Neuropsychopharmacol Biol Psychiatry 6 (1982): 75-82
  9. Pullen GP, Best NR, Maguire J "Anticholinergic drug abuse: a common problem?" Br Med J (Clin Res Ed) 289 (1984): 612-3
  10. Laski E, Taleporos E "Anticholinergic psychosis in a bilingual: a case study." Am J Psychiatry 134 (1977): 1038-40
  11. Wilcox JA "Psychoactive properties of benztropine and trihexyphenidyl." J Psychoactive Drugs 15 (1983): 319-21
  12. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  13. Brower KJ "Smoking of prescription anticholinergic drugs." Am J Psychiatry 144 (1987): 383
  14. Macvicar K "Abuse of antiparkinsonian drugs by psychiatric patients." Am J Psychiatry 134 (1977): 809-11
  15. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  16. Rubinstein JS "Abuse of antiparkinsonism drugs. Feigning of extrapyramidal symptoms to obtain trihexyphenidyl." JAMA 239 (1978): 2365-6
  17. Craig DH, Rosen P "Abuse of antiparkinsonian drugs." Ann Emerg Med 10 (1981): 98-100
  18. Warnes H "Toxic psychosis due to antiparkinsonian drugs." Can Psychiatr Assoc J 12 (1967): 323-6
  19. Mohan D, Mohandas E, Dube S "Trihexyphenidyl abuse." Br J Addict 76 (1981): 195-7
  20. Hidalgo HA, Mowers RM "Anticholinergic drug abuse." DICP 24 (1990): 40-1
  21. Moreau A, Jones BD, Banno V "Chronic central anticholinergic toxicity in manic depressive illness mimicking dementia." Can J Psychiatry 31 (1986): 339-41
  22. Ananth JV, Jain RC "Benztropine psychosis." Can Psychiatr Assoc J 18 (1973): 409-14
View all 22 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol/glycopyrrolate) 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. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  3. Richards DM, Brogden RN "Pirbuterol. A preliminary review of its pharmacological properties and therapeutic efficacy in reversible bronchospastic disease." Drugs 30 (1985): 6-21
  4. 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
  5. 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
  6. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  7. Hibbard JU "Chronic terbutaline therapy and peripartum cardiomyopathy: a case-control study." Hypertens Pregnancy 15 (1996): 183-91
  8. 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
  9. Tranfa CME, Pelaia G, Grembiale RD, Naty S, Durante S, Borrello G "Short-term cardiovascular effects of salmeterol." Chest 113 (1998): 1272-6
  10. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  11. 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
  12. 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
  13. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
  14. 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
  15. Suissa S, Hemmelgarn B, Blais L, Ernst P "Bronchodilators and acute cardiac death." Am J Respir Crit Care Med 154 (1996): 1598-602
  16. 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
  17. Ence TJ, Tashkin DP, Ho D, Child JS "Acute bronchial and cardiovascular effects of oral pirbuterol and metaproterenol." Ann Allergy 43 (1979): 229-36
  18. Chazan R, Droszcz W, Maruchin JE "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol 26 (1988): 385-7
  19. Breeden CC, Safirstein BH "Albuterol and spacer-induced atrial fibrillation." Chest 98 (1990): 762-3
  20. Jenne JW "Can oral beta(2) agonists cause heart failure?" Lancet 352 (1998): 1081-2
  21. Neville E, Corris PA, Vivian J, Nariman S, Gibson GJ "Nebulised salbutamol and angina." Br Med J (Clin Res Ed) 285 (1982): 796-7
  22. 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
  23. Finch JS "Cardiovascular toxicity: clinical evaluation of albuterol, isoproterenol and placebo in rising dose tolerance trial." Ann Allergy 47 (1981): 402-4
  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. 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
  26. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  27. Godfrey S "Worldwide experience with albuterol (salbutamol)." Ann Allergy 47 (1981): 423-6
  28. Wagner JM, Morton MJ, Johnson KA, O'Grady JP, Speroff L "Terbutaline and maternal cardiac function." JAMA 246 (1981): 2697-701
  29. 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
  30. 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
  31. 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
  32. 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
  33. 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
  34. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  35. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  36. 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
  37. 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
  38. "Product Information. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  39. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  40. "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
  41. Kinney EL, Trautlein JJ, Harbaugh CV, Lambert D, Zelis RF "Ventricular tachycardia after terbutaline." JAMA 240 (1978): 2247
  42. 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
  43. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  44. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  45. Shovlin CL, Tam FW "Salbutamol nebuliser and precipitation of critical cardiac ischaemia." Lancet 336 (1990): 1258
  46. Katz M, Robertson PA, Creasy RK "Cardiovascular complications associated with terbutaline treatment for preterm labor." Am J Obstet Gynecol 139 (1981): 605-8
  47. Brogden RN, Speight TM, Avery GS "Terbutaline: a preliminary report of its pharmacological properties and therapeutic efficacy in asthma." Drugs 6 (1973): 324-32
  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. 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
  50. 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
View all 50 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol/glycopyrrolate) 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. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  2. 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
  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. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  6. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  7. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
  8. Hastwell G, Lambert BE "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol 85 (1978): 767-9
  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. Chazan R, Droszcz W, Maruchin JE "Pharmacodynamics of salbutamol in humans." Int J Clin Pharmacol Ther Toxicol 26 (1988): 385-7
  11. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  12. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  13. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  14. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  15. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
View all 15 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol/glycopyrrolate) 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. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  2. Gelmont DM, Balmes JR, Yee A "Hypokalemia induced by inhaled bronchodilators." Chest 94 (1988): 763-6
  3. Allon M, Dunlay R, Copkney C "Nebulized albuterol for acute hyperkalemia in patients on hemodialysis." Ann Intern Med 110 (1989): 426-9
  4. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  5. Whyte KF, Addis GJ, Whitesmith R, Reid JL "The mechanism of salbutamol-induced hypokalaemia." Br J Clin Pharmacol 23 (1987): 65-71
  6. 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
  7. Meyer JM, Wenzel CL, Kradjan WA "Salmeterol: a novel, long-acting beta 2-agonist." Ann Pharmacother 27 (1993): 1478-87
  8. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  9. 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
  10. 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
  11. 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
  12. 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
  13. Hurlbert BJ, Edelman JD, David K "Serum potassium levels during and after terbutaline." Anesth Analg 60 (1981): 723-5
  14. 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
  15. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
  16. Kantola I, Tarssanen L "Hypokalemia from usual salbutamol dosage ." Chest 89 (1986): 619-20
  17. Hastwell G, Lambert BE "The effect of oral salbutamol on serum potassium and blood sugar." Br J Obstet Gynaecol 85 (1978): 767-9
  18. 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
  19. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
  20. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  21. "Hypokalaemia due to salbutamol overdosage." Br Med J (Clin Res Ed) 283 (1981): 500-1
  22. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32
  23. 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
  24. "Product Information. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  25. 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
  26. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  27. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  28. Maconochie JG, Forster JK "Dose-response study with high-dose inhaled salmeterol in healthy subjects." Br J Clin Pharmacol 33 (1992): 342-5
  29. Gross TL, Sokol RJ "Severe hypokalemia and acidosis: a potential complication of beta- adrenergic treatment." Am J Obstet Gynecol 138 (1980): 1225-6
View all 29 references
Moderate

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol/glycopyrrolate) 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. "Product Information. Alupent (metaproterenol)." Boehringer-Ingelheim, Ridgefield, CT.
  2. "Product Information. Proventil (albuterol)." Schering Laboratories, Kenilworth, NJ.
  3. "Product Information. Ventolin (albuterol)." Glaxo Wellcome, Research Triangle Park, NC.
  4. "Product Information. Xopenex (levalbuterol)." Sepracor, Marlborough, MA.
  5. Price AH, Clissold SP "Salbutamol in the 1980s. A reappraisal of its clinical efficacy." Drugs 38 (1989): 77-122
  6. "Product Information. Severent (salmeterol)." Glaxo Wellcome, Research Triangle Park, NC.
  7. "Product Information. Tornalate Metered Dose (bitolterol)." Dura Pharmaceuticals, San Diego, CA.
  8. "Product Information. Maxair (pirbuterol)." 3M Pharmaceuticals, St. Paul, MN.
  9. 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
  10. "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
View all 10 references
Moderate

Budesonide (applies to budesonide/formoterol/glycopyrrolate) 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 budesonide/formoterol/glycopyrrolate) 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.

Moderate

Inhaled corticosteroids (applies to budesonide/formoterol/glycopyrrolate) 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. Monk B, Cunliffe WJ, Layton AM, Rhodes DJ "Acne induced by inhaled corticosteroids." Clin Exp Dermatol 18 (1993): 148-50
  2. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc, Palo Alto, CA.
  4. "Product Information. Nasacort (triamcinolone nasal)." Rhone-Poulenc Rorer, Collegeville, PA.
  5. "Product Information. Flonase (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  6. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
  7. 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
  8. "Product Information. Azmacort (triamcinolone)." Rhone-Polenc Rorer, Collegeville, PA.
  9. Stevens DJ "Cushing's syndrome due to the abuse of betamethasone nasal drops." J Laryngol Otol 102 (1988): 219-21
  10. 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
  11. 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
  12. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra USA, Westborough, MA.
  13. Clark TJ "Safety of inhaled corticosteroids." Eur J Respir Dis Suppl 122 (1982): 235-42
  14. 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
  15. "Product Information. Flovent (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  16. 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
  17. "Product Information. Rhinocort (budesonide)." Astra USA, Westborough, MA.
  18. 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
  19. 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
  20. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  21. Robinson DS, Geddes DM "Inhaled corticosteroids: benefits and risks." J Asthma 33 (1996): 5-16
  22. Kimmerle R, Rolla AR "Iatrogenic Cushing's syndrome due to dexamethasone nasal drops." Am J Med 79 (1985): 535-7
  23. "Product Information. Nasonex nasal spray (mometasone topical)." Schering Laboratories, Kenilworth, NJ.
  24. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
  25. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  26. 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
  27. 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
  28. "Product Information. Aerobid (flunisolide)." Forest Pharmaceuticals, St. Louis, MO.
View all 28 references
Moderate

Inhaled corticosteroids (applies to budesonide/formoterol/glycopyrrolate) 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. Executive Committee American Academy of Allergy and Immunology "Inhaled corticosteroids and severe viral infections." J Allergy Clin Immunol 92 (1993): 223-8
  2. 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
  3. Webb EL "Nasal candidiasis in a patient on long-term topical intranasal corticosteroid therapy." J Allergy Clin Immunol 91 (1993): 680-1
  4. 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
  5. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  6. "Product Information. Flonase (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  7. "Product Information. Azmacort (triamcinolone)." Rhone-Polenc Rorer, Collegeville, PA.
  8. "Product Information. Nasacort (triamcinolone nasal)." Rhone-Poulenc Rorer, Collegeville, PA.
  9. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc, Palo Alto, CA.
  10. "Product Information. Flovent (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  11. Toogood JH, Jennings B, Greenway RW, Chuang L "Candidiasis and dysphonia complicating beclomethasone treatment of asthma." J Allergy Clin Immunol 65 (1980): 145-53
  12. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
  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. Milne LJ, Crompton GK "Beclomethasone dipropionate and oropharyngeal candidiasis." Br Med J 3 (1974): 797-8
  15. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  16. "Product Information. Nasonex nasal spray (mometasone topical)." Schering Laboratories, Kenilworth, NJ.
  17. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
  18. 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
  19. 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
  20. Horton DJ, Spector SL "Clinical pulmonary tuberculosis in an asthmatic patient using a steroid aerosol." Chest 71 (1977): 540-2
  21. Kesten S, Hyland RH, Pruzanski WR, Kortan PP "Esophageal candidiasis associated with beclomethasone dipropionate aerosol therapy." Drug Intell Clin Pharm 22 (1988): 568-9
  22. Vogt FC "The incidence of oral candidiasis with use of inhaled corticosteroids." Ann Allergy 43 (1979): 205-10
  23. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra USA, Westborough, MA.
  24. 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
  25. 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
  26. 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
  27. Shaikh WA "Pulmonary tuberculosis in patients treated with inhaled beclomethasone." Allergy 47 (1992): 327-30
  28. "Product Information. Rhinocort (budesonide)." Astra USA, Westborough, MA.
  29. "Product Information. Aerobid (flunisolide)." Forest Pharmaceuticals, St. Louis, MO.
View all 29 references
Moderate

Inhaled corticosteroids (applies to budesonide/formoterol/glycopyrrolate) 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. Pulmicort Turbuhaler (budesonide)." Astra USA, Westborough, MA.
  2. "Product Information. Azmacort (triamcinolone)." Rhone-Polenc Rorer, Collegeville, PA.
  3. "Product Information. Nasacort (triamcinolone nasal)." Rhone-Poulenc Rorer, Collegeville, PA.
  4. "Product Information. Flovent (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Rhinocort (budesonide)." Astra USA, Westborough, MA.
  6. "Product Information. Flonase (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  7. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
  8. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc, Palo Alto, CA.
  9. "Product Information. Aerobid (flunisolide)." Forest Pharmaceuticals, St. Louis, MO.
  10. "Product Information. Nasonex nasal spray (mometasone topical)." Schering Laboratories, Kenilworth, NJ.
  11. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
View all 11 references
Moderate

Inhaled corticosteroids (applies to budesonide/formoterol/glycopyrrolate) 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. Allen MB, Ray SG, Leitch AG, Dhillon B, Cullen B "Steroid aerosols and cataract formation." BMJ 299 (1989): 432-3
  2. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
  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. 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
  5. "Product Information. Rhinocort (budesonide)." Astra USA, Westborough, MA.
  6. Fraunfelder FT, Meyer SM "Posterior subcapsular cataracts associated with nasal or inhalation corticosteroids." Am J Ophthalmol 109 (1990): 489-90
  7. "Product Information. Nasacort (triamcinolone nasal)." Rhone-Poulenc Rorer, Collegeville, PA.
  8. Cumming RG, Mitchell P, Leeder SR "Use of inhaled corticosteroids and the risk of cataracts." N Engl J Med 337 (1997): 8-14
  9. Ghanchi F "Young patients on inhaled steroids and cataract." Lancet 342 (1993): 1306-7
  10. 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
  11. "Product Information. Vancenase (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
  12. "Product Information. Beclovent (beclomethasone)." Glaxo Wellcome, Research Triangle Park, NC.
  13. 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
  14. "Product Information. Aerobid (flunisolide)." Forest Pharmaceuticals, St. Louis, MO.
  15. "Product Information. Azmacort (triamcinolone)." Rhone-Polenc Rorer, Collegeville, PA.
  16. 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
  17. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  18. 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
  19. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  20. "Product Information. Nasonex nasal spray (mometasone topical)." Schering Laboratories, Kenilworth, NJ.
  21. "Product Information. Flonase (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  22. "Product Information. Nasalide (flunisolide)." Syntex Laboratories Inc, Palo Alto, CA.
  23. "Product Information. Flovent (fluticasone)." Glaxo Wellcome, Research Triangle Park, NC.
  24. "Product Information. Pulmicort Turbuhaler (budesonide)." Astra USA, Westborough, MA.
  25. 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
  26. Dreyer EB "Inhaled steroid use and glaucoma." N Engl J Med 329 (1993): 1822
  27. 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
  28. Karim AK, Thompson GM, Jacob TJ "Steroid aerosols and cataract formation." BMJ 299 (1989): 918
  29. Kewley GD "Possible association between beclomethasone diproprionate aerosol and cataracts." Aust Paediatr J 16 (1980): 117-8
  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
View all 30 references
Moderate

Inhaled corticosteroids (applies to budesonide/formoterol/glycopyrrolate) 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. 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
  2. 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
  3. 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
  4. 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
  5. Barnes PJ "Drug therapy: inhaled glucocorticoids for asthma." N Engl J Med 332 (1995): 868-75
  6. 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
  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. 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
  9. 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
  10. 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
  11. 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
  12. McEvoy CE, Niewoehner DE "Adverse effects of corticosteroid therapy for COPD - A critical review." Chest 111 (1997): 732-43
  13. 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
  14. Kinberg KA, Hopp RJ, Biven RE, Gallagher JC "Bone mineral density in normal and asthmatic children." J Allergy Clin Immunol 94 (1994): 490-7
  15. Howland WC "Fluticasone propionate: topical or systemic effects?" Clin Exp Allergy 26 ( Suppl (1996): 18-22
  16. 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
  17. 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
  18. 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
  19. 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
  20. Ali NJ, Capewell S, Ward MJ "Bone turnover during high dose inhaled corticosteroid treatment." Thorax 46 (1991): 160-4
  21. 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
  22. 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
  23. 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
  24. 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
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Minor

Anticholinergics (applies to budesonide/formoterol/glycopyrrolate) 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. Marezine (cyclizine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. "Product Information. Cogentin (benztropine)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Artane (trihexyphenidyl)." Lederle Laboratories, Wayne, NJ.
  4. "Product Information. Benadryl (diphenhydramine)." Parke-Davis, Morris Plains, NJ.
  5. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.
  6. 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
  7. "Product Information. Antivert (meclizine)." Roerig Division, New York, NY.
View all 7 references
Minor

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

Budesonide / formoterol / glycopyrrolate drug interactions

There are 785 drug interactions with budesonide / formoterol / glycopyrrolate

Budesonide / formoterol / glycopyrrolate alcohol/food interactions

There are 4 alcohol/food interactions with budesonide / formoterol / glycopyrrolate

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.