Drug Interaction Report

MONITOR: Concomitant use of androgens with adrenocorticotropic hormone (ACTH) or corticosteroids may result in increased fluid retention and edema due to additive steroidal effects.

MANAGEMENT: Caution is advised if androgens are used in combination with ACTH or corticosteroids, particularly in patients with conditions that may be aggravated by fluid retention such as cardiovascular, renal, or hepatic diseases.

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.