MajorInhaled corticosteroids (ICS)×Systemic antimycotics. Imidazole derivatives
Updated · Methodology
Mechanism
Ketoconazole strongly blocks CYP3A4 – the main budesonide metabolic route. Systemic budesonide exposure (oral or inhaled) rises 6- to 12-fold. High Cushing's syndrome risk with prolonged combination.
Symptoms
Moon face, central obesity, abdominal striae, hypertension, hyperglycaemia. With prolonged combination and abrupt withdrawal: adrenal insufficiency risk.
Management
The combination is not prescribed. Alternative antifungals: terbinafine for dermatophytosis or echinocandins for systemic mycoses. Alternative inhaled corticosteroid: fluticasone/mometasone (less CYP3A4-dependent).
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.
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Sources
- FDA: Ketoconazole tablet (Amerisyn LLC) – Prescribing Information (2014)– ; DailyMed setid 1d598696-c6f3-4b7c-ad73-949d2089df35
- EMA: Huperzine A is not authorised as a medicinal product in the EU (2024)– EMA – no centralised authorisation for huperzine A
- AEMPS: Ficha técnica: Budesonida (nº registro 59254), sección 4.5 (2023)– AEMPS, CIMA, nº registro 59254, revisión 04/2023, sección 4.5