Budesonide and Voriconazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Voriconazole
Budesonide
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased budesonide exposure, an increased risk of Cushing's syndrome and an increased risk of adrenal dysfunction
Interaction Deep Dive
Avoid concomitant use of budesonide oral delayed-release capsules with voriconazole1 and use caution with budesonide inhalation 2 in combination with strong CYP3A4 inhibitors, as the exposure of budesonide may be increased and it may result in budesonide-related adverse effects 3. In patients taking corticosteroids such as budesonide, voriconazole associated CYP3A4 inhibition of their Concomitant use of voriconazole with budesonide (corticosteroid) may also cause adrenal suppression due to voriconazole associated CYP3A4 inhibition of their metabolism. Cushing's syndrome with and without subsequent adrenal insufficiency has also been reported in patients receiving voriconazole concomitantly with corticosteroids. Monitor patients receiving voriconazole and corticosteroids (via all routes of administration) for adrenal dysfunction, both during and after voriconazole treatment. Instruct patients to seek immediate medical care if they develop signs and symptoms of Cushing's syndrome or adrenal insufficiency 4.
Why it happens (mechanism)
Direct inhibition of steroidogenesis by azoles; inhibition of CYP3A4-mediated metabolism of budesonide
Literature reports
1 report — tap to read
a) Ketoconazole and itraconazole, strong inhibitors of CYP3A4, the main metabolic enzyme for corticosteroids, increased plasma levels of orally ingested budesonide and orally inhaled budesonide, respectively 3.
Common questions
Can I take Budesonide and Voriconazole together?
Increased budesonide exposure, an increased risk of Cushing's syndrome and an increased risk of adrenal dysfunction Always confirm with your pharmacist or prescriber before making any change.
How serious is the Budesonide and Voriconazole interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Budesonide or Voriconazole need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: TARPEYO(TM) oral delayed-release capsules, budesonide oral delayed-release capsules. Calliditas Therapeutics AB (per FDA), Stockholm, Sweden, 2021. DailyMed
- Product Information: AIRSUPRA(TM) oral inhalation aerosol, albuterol budesonide oral inhalation aerosol. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2023. DailyMed
- Product Information: SYMBICORT AEROSPHERE(R) oral inhalation aerosol, budesonide formoterol fumarate oral inhalation aerosol. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2023.
- Product Information: VFEND(R) oral tablets, oral suspension, intravenous injection, voriconazole oral tablets, oral suspension, intravenous injection. Roerig (per FDA), New York, NY, 2025. DailyMed
Keep reading about Voriconazole
Keep reading about Budesonide
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist