Drug Interactions between budesonide and landiolol

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.

Landiolol is contraindicated in patients with cardiogenic shock as it may precipitate further cardiovascular collapse and cause cardiac arrest.

Landiolol is contraindicated in patients with decompensated heart failure. Beta-blockers (like landiolol) can depress myocardial contractility and may precipitate heart failure and cardiogenic shock. At first sign/symptom of impending cardiac failure, landiolol should be stopped and supportive therapy should be started.

Landiolol is contraindicated in patients with severe sinus bradycardia, sick sinus syndrome, or heart block greater than first degree. Patients with first-degree atrioventricular block, sinus node dysfunction, or conduction disorders are at increased risk of bradycardia (including sinus pause, heart block, severe bradycardia, and cardiac arrest). Heart rate and rhythm should be monitored in patients receiving landiolol. If bradyarrhythmia occurs, landiolol should be reduced or stopped.

Landiolol is contraindicated in patients with pulmonary hypertension as it may precipitate cardiorespiratory decompensation.

Landiolol is contraindicated in patients with severe sinus bradycardia, sick sinus syndrome, or heart block greater than first degree. Patients with first-degree atrioventricular block, sinus node dysfunction, or conduction disorders are at increased risk of bradycardia (including sinus pause, heart block, severe bradycardia, and cardiac arrest). Heart rate and rhythm should be monitored in patients receiving landiolol. If bradyarrhythmia occurs, landiolol should be reduced or stopped.

Hyperkalemic renal tubular acidosis may occur in patients with metabolic acidosis receiving landiolol; beta-blockers have been reported to cause this condition. Acidosis in general may be associated with reduced cardiac contractility.

When using beta-blockers (like landiolol), patients at risk of anaphylactic reactions may be more reactive to allergen exposure (accidental, diagnostic, or therapeutic). Patients using beta-blockers may be unresponsive to the usual doses of epinephrine used to treat anaphylactic or anaphylactoid reactions.

Patients with reactive airways disease should generally not receive beta-blockers (like landiolol). Because of the relative beta-1 selectivity and titratability, landiolol may be titrated to the lowest possible effective dose. If bronchospasm occurs, the infusion should be stopped immediately; a beta-2 stimulating agent may be administered with appropriate monitoring of ventricular rates.

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.

Patients with reactive airways disease should generally not receive beta-blockers (like landiolol). Because of the relative beta-1 selectivity and titratability, landiolol may be titrated to the lowest possible effective dose. If bronchospasm occurs, the infusion should be stopped immediately; a beta-2 stimulating agent may be administered with appropriate monitoring of ventricular rates.

Patients with hemodynamic compromise, hypovolemia, or on interacting medications are at increased risk of hypotension while taking landiolol. Blood pressure should be monitored closely, especially if pretreatment blood pressure was low. Landiolol should be reduced or stopped for hypotension; the blood pressure effect should wane within 30 minutes.

Landiolol may prevent early warning signs of hypoglycemia (e.g., tachycardia) and increase the risk for severe/prolonged hypoglycemia at any time during treatment, especially in patients with diabetes mellitus or patients who are fasting (e.g., surgery, not eating regularly, or are vomiting). Patients receiving landiolol should be monitored for signs/symptoms of hypoglycemia.

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.

When landiolol is used in patients with hyperthyroidism, certain clinical signs (e.g., tachycardia) of hyperthyroidism may be masked by beta-adrenergic blockade. Abrupt withdrawal of beta-blockers may precipitate a thyroid storm. Patients should be monitored for signs of thyrotoxicosis when withdrawing landiolol therapy.

Landiolol may prevent early warning signs of hypoglycemia (e.g., tachycardia) and increase the risk for severe/prolonged hypoglycemia at any time during treatment, especially in patients with diabetes mellitus or patients who are fasting (e.g., surgery, not eating regularly, or are vomiting). Patients receiving landiolol should be monitored for signs/symptoms of hypoglycemia.

Patients with hemodynamic compromise, hypovolemia, or on interacting medications are at increased risk of hypotension while taking landiolol. Blood pressure should be monitored closely, especially if pretreatment blood pressure was low. Landiolol should be reduced or stopped for hypotension; the blood pressure effect should wane within 30 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.

Patients should be observed for signs of myocardial ischemia when discontinuing landiolol. Severe exacerbations of angina, myocardial infarction, and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt discontinuation of beta-blocker therapy.

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.

The effect of moderate or severe liver dysfunction (Child-Pugh B or C) on landiolol pharmacokinetics is unknown; use of landiolol should be avoided in patients with moderate or severe liver dysfunction. In patients with mild liver dysfunction (Child-Pugh A), more conservative dose titration is recommended.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

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.

Landiolol may exacerbate peripheral circulatory disorders (e.g., Raynaud's disease/syndrome) and peripheral occlusive vascular disease.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta receptor-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

Landiolol may exacerbate anginal attacks in patients with Prinzmetal angina due to unopposed alpha receptor-mediated coronary artery vasoconstriction.

Landiolol can cause increases in serum potassium and hyperkalemia; the risk is increased in patients with risk factors such as renal dysfunction. Potentially life-threatening hyperkalemia has been reported in hemodialysis patients administered IV beta-blockers. Serum electrolytes should be monitored during landiolol therapy. The effect of renal dysfunction on landiolol pharmacokinetics is unknown.

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.