Drug Interactions between budesonide and cholera vaccine

Administration of cholera vaccine with food or drink may reduce its effectiveness. Avoid eating or drinking for 60 minutes before and after taking cholera vaccine.

You should avoid the regular consumption of large amounts of grapefruits and grapefruit juice while taking budesonide. Grapefruit can raise the levels of budesonide in your body and lead to increased side effects. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Ideally, vaccination should occur when an individual is healthy, thus minimizing the risk of an adverse host reaction and/or vaccine failure. However, a current or recent infection does not necessarily preclude the use of vaccines, depending on the severity of the patient's symptoms and their etiology. Superficial infections and minor acute illnesses such as a mild upper respiratory infection with or without low-grade fever do not contraindicate immunization, particularly if prompt administration of a vaccine is deemed necessary or beneficial. In fact, when vaccines are administered during the course of a minor illness, the risk of adverse events is not increased, and serum antibody response is not often diminished. On the other hand, if fever or symptoms suggest a moderate or severe illness, it is usually appropriate to withhold vaccination until the patient has recovered. In addition to the potential risks already mentioned, evolving signs and symptoms of the illness can sometimes confound the diagnosis of a vaccine reaction if it develops. In the presence of any infection, the decision to administer or withhold/defer immunization should take into consideration the benefits versus the risks to an individual patient.

Ideally, vaccination should occur when an individual is healthy, thus minimizing the risk of an adverse host reaction and/or vaccine failure. However, a current or recent infection does not necessarily preclude the use of vaccines, depending on the severity of the patient's symptoms and their etiology. Superficial infections and minor acute illnesses such as a mild upper respiratory infection with or without low-grade fever do not contraindicate immunization, particularly if prompt administration of a vaccine is deemed necessary or beneficial. In fact, when vaccines are administered during the course of a minor illness, the risk of adverse events is not increased, and serum antibody response is not often diminished. On the other hand, if fever or symptoms suggest a moderate or severe illness, it is usually appropriate to withhold vaccination until the patient has recovered. In addition to the potential risks already mentioned, evolving signs and symptoms of the illness can sometimes confound the diagnosis of a vaccine reaction if it develops. In the presence of any infection, the decision to administer or withhold/defer immunization should take into consideration the benefits versus the risks to an individual patient.

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 corticosteroids 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.

In patients with thrombocytopenia or coagulation disorders, IM injections may produce bleeding and hematomas. Patients with a platelet count less than 50,000/mm3 are at an increased risk. Caution is advised if the vaccine (e.g., plague vaccine; hepatitis A and B vaccines; aluminum-adsorbed DTaP, DTP, DT, or Td) must be administered IM. The risk of bleeding may be minimized by vaccination immediately after the administration of replacement factor, use of a 23-gauge (or smaller) needle, and immediate application of direct pressure to the vaccination site for at least 2 minutes.

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 corticosteroids 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.

The use of 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.

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 corticosteroids should be administered cautiously in patients with an infection, particularly active or quiescent tuberculosis or in hepatitis B carriers. Monitor patients for any new or worsening infection and use with caution in these patients. A serious or even fatal course of chickenpox and measles can occur in susceptible patients. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.

Some inhaled corticosteroid formulations contain lactose and may cause adverse reactions including cough, wheezing and bronchospasm in patients with severe milk protein allergy or intolerance. Caution is advised.

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.

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.

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 or more of beclomethasone or equivalent for 1 year or greater). 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.

In patients with thrombocytopenia or coagulation disorders, IM injections may produce bleeding and hematomas. Patients with a platelet count less than 50,000/mm3 are at an increased risk. Caution is advised if the vaccine (e.g., plague vaccine; hepatitis A and B vaccines; aluminum-adsorbed DTaP, DTP, DT, or Td) must be administered IM. The risk of bleeding may be minimized by vaccination immediately after the administration of replacement factor, use of a 23-gauge (or smaller) needle, and immediate application of direct pressure to the vaccination site for at least 2 minutes.

In patients with thrombocytopenia or coagulation disorders, IM injections may produce bleeding and hematomas. Patients with a platelet count less than 50,000/mm3 are at an increased risk. Caution is advised if the vaccine (e.g., plague vaccine; hepatitis A and B vaccines; aluminum-adsorbed DTaP, DTP, DT, or Td) must be administered IM. The risk of bleeding may be minimized by vaccination immediately after the administration of replacement factor, use of a 23-gauge (or smaller) needle, and immediate application of direct pressure to the vaccination site for at least 2 minutes.

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 corticosteroids should be administered cautiously in patients with an infection, particularly active or quiescent tuberculosis or in hepatitis B carriers. Monitor patients for any new or worsening infection and use with caution in these patients. A serious or even fatal course of chickenpox and measles can occur in susceptible patients. It is important that the recommended dosages of the individual products not be exceeded and that the lowest effective dosage be used.