Moderate
Amiodarone × Budesonide
Class III antiarrhythmics (Vaughan Williams)×Inhaled corticosteroids (ICS)
Mechanism
Amiodarone inhibits CYP3A4 — the enzyme responsible for budesonide metabolism. Oral budesonide levels may rise, increasing iatrogenic hypercortisolism risk in long-term therapy. Inhaled budesonide is minimally absorbed — the effect is weaker.
Symptoms
On long-term therapy: moon face, weight gain with fat redistribution, skin thinning, acne, muscle weakness, mood disturbance, hyperglycaemia.
Management
For inhaled budesonide (Symbicort, Pulmicort) plus amiodarone, no adjustment needed. On oral budesonide (Cortiment, Entocort) over 8 weeks, assess for hypercortisolism and consider dose reduction or switching to mesalazine (in Crohn's disease). Amiodarone alternative in atrial fibrillation: dronedarone (no CYP3A4 effect).
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.