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Symbicort and Alcohol/Food Interactions

There are 4 alcohol/food/lifestyle interactions with Symbicort (budesonide / formoterol).


Caffeine Formoterol

Moderate Drug Interaction

Both caffeine and formoterol can increase blood pressure and heart rate, and combining them may enhance these effects. Talk to your doctor before using these medications, especially if you have a history of high blood pressure or heart disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data


Budesonide Caffeine

Minor Drug Interaction

Information for this minor interaction is available on the professional version.


Budesonide Food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

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.


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

Formoterol High Blood Pressure (Hypertension)

Moderate Potential Hazard, Moderate plausibility

beta- 2 adrenergic bronchodilators - cardiovascular

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.


  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

Symbicort drug interactions

There are 803 drug interactions with Symbicort (budesonide / formoterol).

Symbicort disease interactions

There are 11 disease interactions with Symbicort (budesonide / formoterol) which include:

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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.