CYP3A4 Inhibitors: Concomitant use of inhaled budesonide and cytochrome P450 inhibitors particularly isoenzyme CYP3A4 (i.e., cobicistat-containing products, ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin, itraconazole) increases the concentration of budesonide in the plasma leading to increased risk of systemic side-effects such as Cushing's syndrome and adrenal suppression. If used, close monitoring of patients is advised for any systemic effects. Otherwise, the combination should be avoided unless the benefit outweighs the risk. Short term use (1 to 2 weeks) of ketoconazole concomitantly with budesonide is not associated with clinically significant drug interaction.
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