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Drug Interactions between Restora Rx and Symbicort

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

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Interactions between your drugs

Moderate

budesonide lactobacillus casei

Applies to: Symbicort (budesonide / formoterol) and Restora Rx (folic acid / lactobacillus casei)

MONITOR: Probiotic use during immunosuppressant or intense antineoplastic therapy may theoretically increase the risk of infections from the live microorganisms contained in probiotic products. Patients may be immunosuppressed if they have recently received or are receiving alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents, or long-term topical or inhaled corticosteroids. Although probiotics are generally considered safe, with minimal to low pathogenicity, infections such as bacteremia and endocarditis with various strains commonly found in probiotics (e.g., lactobacilli, bifidobacteria, Bacillus subtilis) have been rarely reported, primarily in critically ill patients or patients with significant underlying medical conditions such as malignancy, organ transplantation, AIDS, valvular heart disease, diabetes mellitus, recent surgery, or compromised immune system. Lactobacillus bacteremia has also been reported following endoscopy. In addition, cases of lactobacillus pneumonia and liver abscess, as well as Saccharomyces fungemia, pneumonia, liver abscess, peritonitis and vaginitis, have been described in the medical literature.

MANAGEMENT: Caution is advised when probiotics are used during immunosuppressant or intense antineoplastic therapy. It may be advisable to avoid using probiotics, particularly products containing saccharomyces boulardii, in patients who are significantly immunosuppressed unless benefits are anticipated to outweigh the potential risk of infection.

References

  1. Salminen MK, Rautelin H, Tynkkynen S, et al. "Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG." Clin Infect Dis 38 (2004): 62-9
  2. Salminen MK, Tynkkynen S, Rautelin H, et al. "Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland." Clin Infect Dis 35 (2002): 1155-60
  3. Rautio M, Jousimies-Somer H, Kauma H, et al. "Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG." Clin Infect Dis 28 (1999): 1159-60
  4. Schlegel L, Lemerle S, Geslin P "Lactobacillus species as opportunistic pathogens in immunocompromised patients." Eur J Clin Microbiol Infect Dis 17 (1998): 887-8
  5. Saxelin M, Chuang NH, Chassy B, et al. "Lactobacilli and bacteremia in southern Finland, 1989-1992" Clin Infect Dis 22 (1996): 564-6
  6. Husni RN, Gordon SM, Washington JA, Longworth DL "Lactobacillus bacteremia and endocarditis: review of 45 cases." Clin Infect Dis 25 (1997): 1048-55
  7. Oggioni MR, Pozzi G, Valensin PE, Galieni P, Bigazzi C "Recurrent septicemia in an immunocompromised patient due to probiotic strains of Bacillus subtilis." J Clin Microbiol 36 (1998): 325-6
  8. Mackay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM "Lactobacillus endocarditis caused by a probiotic organism." Clin Microbiol Infect 5 (1999): 290-2
  9. Borriello SP, Hammes WP, Holzapfel W, et al. "Safety of probiotics that contain lactobacilli or bifidobacteria." Clin Infect Dis 36 (2003): 775-80
  10. Lolis N, Veldekis D, Moraitou H, et al. "Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin." Crit Care 12 (2008): epub
  11. Boyle RJ, Robins-Browne RM, Tang ML "Probiotic use in clinical practice: what are the risks?" Am J Clin Nutr 83 (2006): 1256-64
  12. Pruccoli G, Silvestro E, Napoleone CP, Aidala E, Garazzino S, Scolfaro C "Are probiotics safe? Bifidobacterium bacteremia in a child with severe heart failure. https://www.researchgate.net/publication/333853508_Are_probiotics_safe_Bifidobacterium_bacteremia_in_a_child_with_severe_heart_failure" (2024):
View all 12 references

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Minor

budesonide formoterol

Applies to: Symbicort (budesonide / formoterol) and Symbicort (budesonide / formoterol)

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the potential significance is unknown. Patients who are receiving systemic or nebulized formulations of beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be at a greater risk of developing hypokalemia.

References

  1. "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
View all 4 references

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Drug and food interactions

Moderate

folic acid food

Applies to: Restora Rx (folic acid / lactobacillus casei)

MONITOR: Ethanol may increase folic acid elimination and folic acid absorption is decreased in chronic alcoholics. Excessive alcohol consumption may lead to folate deficiency.

MANAGEMENT: Monitoring of patient response to folic acid supplementation if they also consume alcohol regularly may be recommended.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  4. Cerner Multum, Inc "ANVISA Bulário Eletrônico." O 0 (2015):
  5. "Product Information. Folic Acid (folic acid)." Method Pharmaceuticals, LLC (2017):
View all 5 references

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Moderate

budesonide food

Applies to: Symbicort (budesonide / formoterol)

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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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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