Amiodarone with Budesonide Interaction Details

Brand Names Associated with Amiodarone

Brand Names Associated with Budesonide

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Feb 27, 2024

Interaction Effect

Increased risk of developing Cushing's syndrome

Interaction Summary

Cushing's syndrome as a result of oral budesonide treatment in a patient receiving amiodarone has been reported. It has been suggested that the development of Cushing's syndrome is due to a decrease or inhibition of cytochrome P450 3A-mediated metabolism of budesonide by amiodarone[1].

Severity

Minor

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Close clinical monitoring is necessary in patients being treated with budesonide and amiodarone or any other drug metabolized by cytochrome P450 3A (CYP3A).

Mechanism Of Interaction

Inhibition of CYP3A-mediated metabolism of budesonide by amiodarone

Literature Reports

A) An 81-year-old male known to have paroxysmal atrial fibrillation and chronic renal insufficiency developed Cushing's syndrome while being treated with concomitant amiodarone and budesonide [1]. The patient presented with diarrhea. Prednisone was used after treatment with 5-ASA failed. After six months of prednisone therapy, budesonide (9 mg/day) was initiated and the diarrhea subsequently disappeared within six weeks. Diarrhea recurred when attempts were made to reduce the dose of budesonide. Eleven months later the patient presented with arterial hypertension, mooning, abdominal obesity, fragile skin with multiple hematomae, furunculosis, and thrombophlebitis. Budesonide was reduced to 3 mg/day. Diarrhea recurred and Cushingoid symptoms remained. ACTH and plasma cortisol were within normal limits. The patient was reexposed to 6 mg/day of budesonide for two weeks. One month later, ACTH, plasma cortisol, and free urine cortisol were normal while all signs of Cushing's syndrome persisted. Amiodarone treatment was discontinued and budesonide treatment was continued at 3 mg/day. The clinical signs of Cushing's syndrome disappeared after 4 weeks.

References

1 ) Ahle G, Blum A, Martinek J, et al: Cushing's syndrome in an 81-year-old patient treated with budesonide and amiodarone. Eur J Gastroenterol Hepatol 2000; 12(9):1041-1042.

Amiodarone Overview

• Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.

Budesonide Overview

• Budesonide (Entocort EC) is used to treat Crohn's disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever). Budesonide (Tarpeyo) is used to decrease protein in the urine in patients with primary immunoglobulin A nephropathy (kidney disease that occurs in some people when too much immunoglobin A builds up in the kidney, causing inflammation). Budesonide is in a class of medications called corticosteroids. It works by decreasing inflammation (swelling) in the digestive tract of people who have Crohn's disease or in the kidney of people with nephropathy.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.