Drug Interaction Report

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GENERALLY AVOID: The administration of live, attenuated virus or bacterial vaccines during corticosteroid therapy may be associated with a risk of disseminated infection due to enhanced replication of vaccine virus or bacteria in the presence of diminished immune competence. Patients may be immunosuppressed if they have recently received or are receiving high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than or equal to 2 mg/kg/day or 20 mg/day of prednisone or equivalent for 14 consecutive days or more), or long-term topical or inhaled corticosteroids. Such patients may also have increased adverse reactions and decreased or suboptimal immunologic response to vaccines. With respect to chronic corticosteroid inhalation therapy, a study was conducted to examine immune responsiveness to varicella vaccine in pediatric asthma patients ages 12 months to 8 years treated with budesonide inhalation suspension 0.25 mg to 1 mg daily. Compared to patients on noncorticosteroid asthma therapy, there was no significant difference in the percentage of budesonide patients who developed a seroprotective antibody titer following vaccination (85% vs. 90% for noncorticosteroid). In addition, no patient treated with budesonide inhalation suspension developed chicken pox as a result of vaccination.

MANAGEMENT: In general, live attenuated vaccines should not be used in patients receiving immunosuppressive corticosteroid therapy. Vaccination should be deferred until after such therapy is discontinued and immune function has been restored. The interval depends on the dosage and duration of corticosteroid therapy administered, but may be at least 3 months in most cases. Current local immunization guidelines should be consulted for recommendations. In patients who have recently been vaccinated, high-dose corticosteroid therapy should not be initiated for at least 2 weeks. Vaccines may generally be administered to patients receiving corticosteroids as replacement therapy (e.g., for Addison's disease).

You should avoid the regular consumption of large amounts of grapefruits and grapefruit juice while taking budesonide. Grapefruit can raise the levels of budesonide in your body and lead to increased side effects. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

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ADJUST DOSING INTERVAL: Coadministration of oral cholera vaccine with food or an oral beverage may impair its efficacy. The formulations of both the inactivated and live, attenuated oral cholera vaccines (Dukoral and Vaxchora, respectively) are acid-labile, and must be administered with a buffer. According to the manufacturer, eating and drinking may interfere with the protective effect of the buffer. However, clinical data are not available.

MANAGEMENT: It is recommended that patients avoid eating or drinking for 60 minutes before and after administration of either Dukoral or Vaxchora oral cholera vaccines.