Drug interactions
Budesonide-formoterol + Cobicistat
Severity: Major
Budesonide-formoterol and Cobicistat: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Cobicistat is a strong CYP3A4 inhibitor and markedly raises systemic budesonide exposure. This can cause iatrogenic Cushing syndrome and adrenal suppression, even with inhaled budesonide during long-term use.
What this interaction means in plain words
Budesonide-formoterol and Cobicistat can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Budesonide-formoterol belongs to Respiratory; Cobicistat belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4-mediated first-pass and systemic metabolism of budesonide.
What to do
Avoid long-term combination where possible and consider an alternative corticosteroid less dependent on CYP3A4, such as beclomethasone. If it must be used, monitor for Cushingoid features and adrenal suppression.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Budesonide-formoterol
Other interactions of Cobicistat
- Alfuzosin + Cobicistat Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Cobicistat + Colchicine Contraindicated
- Cobicistat + Dronedarone Contraindicated
- Cobicistat + Eletriptan Contraindicated
- Cobicistat + Eplerenone Contraindicated
Frequently asked questions
Can I take Budesonide-formoterol with Cobicistat?
MediHelp rates the interaction as major. Budesonide-formoterol and Cobicistat can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Cobicistat is a strong CYP3A4 inhibitor and markedly raises systemic budesonide exposure. This can cause iatrogenic Cushing syndrome and adrenal suppression, even with inhaled budesonide during long-term use.
How serious is the interaction between Budesonide-formoterol and Cobicistat?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid long-term combination where possible and consider an alternative corticosteroid less dependent on CYP3A4, such as beclomethasone. If it must be used, monitor for Cushingoid features and adrenal suppression.
What other medicines interact with Budesonide-formoterol?
MediHelp also lists interactions of Budesonide-formoterol with, for example, Adagrasib, Amiodarone, Amisulpride. The full list is on the Budesonide-formoterol page.
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