Drug Interaction Report

GENERALLY AVOID: The use of interleukin-1 blockers with other immunosuppressive or myelosuppressive agents may increase the risk of infections. Interleukin-1 blockade alone may cause neutropenia and serious infections, and the risk may be increased in the presence of other immunosuppressive therapy. Agents that may be significantly myelo- or immunosuppressive include antineoplastic agents, radiation, zidovudine, linezolid, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (greater than 10 mg/day to 1 mg/kg/day, whichever is less, of prednisone or equivalent for more than 2 weeks), and long-term topical or inhaled corticosteroids.

MANAGEMENT: The safety and efficacy of interleukin-1 blockers in immunosuppressed patients have not been established. Until more information is available, interleukin-1 blockers should preferably not be administered to immunosuppressed patients, or they should be prescribed with extreme caution. Interleukin-1 blockers should be discontinued if neutropenia or serious infection occurs.

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.