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Drug Interactions between Elestrin and Pulmicort Turbuhaler

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

estradiol budesonide

Applies to: Elestrin (estradiol) and Pulmicort Turbuhaler (budesonide)

MONITOR: Estrogens may enhance the systemic effects of both endogenous and exogenous corticosteroids. The proposed mechanism is an increase in serum cortisol-binding globulin (transcortin) induced by estrogens, resulting in a decreased rate of corticosteroid metabolic clearance. The interaction has been reported with estrogens or estrogen-containing oral contraceptives (OCs) and hydrocortisone, prednisone, and prednisolone. In one pharmacokinetic study, the mean plasma clearance of total prednisolone (40 mg IV) in eight female OC users was less than half that of five healthy female non-OC users and eight healthy males, and the prednisolone half-life and mean residence time were longer. There was also a 2-fold increase in the area under the plasma concentration-time curve for unbound prednisolone compared to controls.

MANAGEMENT: Patients treated concomitantly with an estrogen-containing drug may require lower dosages of corticosteroids or adrenocorticotropic agents. Pharmacologic response to these agents should be monitored more closely whenever an estrogen is added to or withdrawn from therapy in patients stabilized on their existing corticosteroid or adrenocorticotropic regimen, and the dosage(s) adjusted as necessary.

References

  1. Frey BM, Schaad HJ, Frey FJ "Pharmacokinetic interaction of contraceptive steroids with prednisone and prednisolone." Eur J Clin Pharmacol 26 (1984): 505-11
  2. Meffin PJ, Wing LM, Sallustio BC, Brooks PM "Alterations in prednisolone as a result of oral contraceptive use and dose." Br J Clin Pharmacol 17 (1984): 655-64
  3. Legler UF, Benet LZ "Marked alterations in dose-dependent prednisolone kinetics in women taking oral contraceptives." Clin Pharmacol Ther 39 (1986): 425-9
  4. Olivesi A "Modified elimination of prednisolone in epileptic patients on carbamazepine monotherapy, and in women using low-dose oral contraceptives." Biomed Pharmacother 40 (1986): 301-8
  5. Boekenoogen SJ, Szefler SJ, Jusko WJ "Prednisolone disposition and protein binding in oral contraceptive users." J Clin Endocrinol Metab 56 (1983): 702-8
  6. "Product Information. Ortho-Novum 1/35 (ethinyl estradiol-norethindrone)." Ortho McNeil Pharmaceutical
  7. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories PROD (2001):
  8. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 8 references

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Drug and food interactions

Moderate

budesonide food

Applies to: Pulmicort Turbuhaler (budesonide)

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations and systemic effects of orally administered budesonide. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. According to the manufacturer, the systemic exposure of oral budesonide approximately doubles after extensive intake of grapefruit juice.

MANAGEMENT: Patients receiving budesonide should avoid the regular consumption of grapefruits and grapefruit juice to prevent undue increases in plasma budesonide levels and systemic effects.

References

  1. "Product Information. Entocort (budesonide)." AstraZeneca Pharma Inc (2001):

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Minor

estradiol food

Applies to: Elestrin (estradiol)

Coadministration with grapefruit juice may increase the bioavailability of oral estrogens. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall induced by certain compounds present in grapefruits. In a small, randomized, crossover study, the administration of ethinyl estradiol with grapefruit juice (compared to herbal tea) increased peak plasma drug concentration (Cmax) by 37% and area under the concentration-time curve (AUC) by 28%. Based on these findings, grapefruit juice is unlikely to affect the overall safety profile of ethinyl estradiol. However, as with other drug interactions involving grapefruit juice, the pharmacokinetic alterations are subject to a high degree of interpatient variability. Also, the effect on other estrogens has not been studied.

References

  1. Weber A, Jager R, Borner A, et al. "Can grapefruit juice influence ethinyl estradiol bioavailability?" Contraception 53 (1996): 41-7
  2. Schubert W, Eriksson U, Edgar B, Cullberg G, Hedner T "Flavonoids in grapefruit juice inhibit the in vitro hepatic metabolism of 17B-estradiol." Eur J Drug Metab Pharmacokinet 20 (1995): 219-24

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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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

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