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Budesonide/formoterol Disease Interactions

There are 11 disease interactions with budesonide / formoterol.

Moderate

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol) cardiovascular

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

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

References

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

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol) diabetes

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

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

References

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

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol) hypokalemia

Moderate Potential Hazard, Moderate plausibility.

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

References

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

Beta- 2 adrenergic bronchodilators (applies to budesonide/formoterol) seizures

Moderate Potential Hazard, Low plausibility.

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

References

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

Budesonide (applies to budesonide/formoterol) 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) hepatic impairment

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

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

References

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

Inhaled corticosteroids (applies to budesonide/formoterol) hyperadrenocorticism

Moderate Potential Hazard, Moderate plausibility.

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

References

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

Inhaled corticosteroids (applies to budesonide/formoterol) infections

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

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

References

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

Inhaled corticosteroids (applies to budesonide/formoterol) ocular herpes simplex

Moderate Potential Hazard, Moderate plausibility.

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

References

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

Inhaled corticosteroids (applies to budesonide/formoterol) ocular toxicities

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

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

References

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

Inhaled corticosteroids (applies to budesonide/formoterol) osteoporosis

Moderate Potential Hazard, Moderate plausibility.

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

References

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

Budesonide/formoterol drug interactions

There are 796 drug interactions with budesonide / formoterol.

Budesonide/formoterol alcohol/food interactions

There are 3 alcohol/food interactions with budesonide / formoterol.


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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.