ModerateInhaled corticosteroids (ICS)×ACE inhibitor
Updated · Methodology
Mechanism
Systemic budesonide retains sodium and water via mineralocorticoid effect (weaker than prednisolone), antagonising the ACE inhibitor's antihypertensive effect. Inhaled budesonide does not clinically affect BP.
Symptoms
On long-term therapy: return or rise of blood pressure, leg oedema. Hyperkalaemia possible with reduced renal function.
Management
For short systemic budesonide courses (3–7 days), no specific adjustment needed. For long-term therapy, check BP weekly in the first month. If BP rises, intensify antihypertensives or switch to an oral corticosteroid with less mineralocorticoid activity (methylprednisolone). Inhaled budesonide with captopril is unproblematic.
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Sources
- FDA: Captopril tablet (Amici Pharma, Inc.) – Prescribing Information (2012)– ; DailyMed setid 1395ba5b-2fc9-41ff-9c43-e0740d781dee