Pulmicort (budesonide) is a brand-name prescription drug. It’s used as a long-term asthma treatment for adults and certain children. As with other medications, Pulmicort can interact with some other drugs. It can also interact with specific supplements and foods. An interaction occurs when one substance causes another substance to have a different effect than expected.
Pulmicort Flexhaler vs. Pulmicort Respules
Pulmicort comes in different forms, and they have the same interactions. The forms are:
- Pulmicort Flexhaler (dry powder inhaler)
- Pulmicort Respules (liquid-filled containers that are used with a nebulizer)
- Pulmicort Turbuhaler (dry powder inhaler that’s no longer available in the United States, but may be available in other countries)
For details about Pulmicort’s interactions, keep reading. For additional information about Pulmicort, including details about its uses, see this article.
Note: Pulmicort isn’t typically used alone to treat asthma. Your doctor will likely also prescribe a rescue inhaler. This type of inhaler is used to relieve symptoms of an asthma attack. Pulmicort is not a rescue inhaler.
In some cases, a factor or condition could prevent your doctor from prescribing Pulmicort due to the risk of harm. This is known as a contraindication. The contraindications of Pulmicort include:
Having acute severe asthma
Pulmicort is an everyday treatment for asthma. It’s not meant to be used as a rescue inhaler for acute (sudden) asthma attacks. Because of this, doctors typically won’t prescribe Pulmicort to treat acute severe asthma, also called acute asthma exacerbation or status asthmaticus. Acute severe asthma is a life threatening medical emergency.
Symptoms of acute severe asthma can include:
- difficulty taking deep breaths or speaking
- shortness of breath
- blue or gray tinge to fingernails and lips
Sometimes it can be difficult to recognize the severity of these symptoms.
If acute severe asthma is not treated right away, in some cases it can be fatal. If you think you have symptoms of acute severe asthma, immediately call 911 or have someone take you to the closest emergency room.
Having had an allergic reaction to Pulmicort or any of its ingredients
If you have had an allergic reaction to Pulmicort or any of its ingredients, your doctor will likely not prescribe Pulmicort. Using the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
Having a severe milk allergy
If you have a severe milk allergy, your doctor will likely not prescribe Pulmicort Flexhaler. This form of the drug contains a type of sugar called lactose, which can contain milk proteins in small amounts. Using Pulmicort Flexhaler could cause an allergic reaction if you’re severely allergic to milk. Pulmicort Respules does not contain lactose, but this form is for use only in children ages 1 year to 8 years.
Your doctor can recommend a treatment other than Pulmicort.
Note: Before you start treatment with Pulmicort, it’s important to tell your doctor if any of these contraindications apply to you. They can determine whether to prescribe Pulmicort.
There’s no known interaction between Pulmicort and alcohol. However, drinking alcohol can trigger asthma symptoms in some people.
If you drink alcohol and have asthma, talk with your doctor about possible risks with Pulmicort.
Before you start treatment with Pulmicort, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them and following any special instructions they give you, you may help prevent possible interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Here’s a chart of drugs that can interact with Pulmicort. Keep in mind that this chart does not include all drugs that may interact with Pulmicort. Some of these interactions are described in detail just below in “Drug interactions in depth.”
|Drug type||Drug examples||Interaction result with Pulmicort|
|CYP3A4 inhibitors||• ketoconazole|
• duvelisib (Copiktra)
|can increase the risk of side effects of Pulmicort*|
|vigabatrin (Sabril)||—||can increase the risk of side effects of Pulmicort* and vigabatrin|
|desmopressin (DDVAP, Nocdurna)||—||can increase the risk of side effects of desmopressin|
* To learn about the side effects of Pulmicort, see this article.
Here’s a closer look at certain drug interactions of Pulmicort.
Pulmicort can interact with medications that are CYP3A4 inhibitors. CYP stands for cytochrome P450, which refers to a group of enzymes (proteins). These enzymes break down certain medications in your body after you take a dose.
Interaction result. UsingPulmicort with a CYP3A4 inhibitor can increase your risk of side effects from Pulmicort. Examples include a runny nose or respiratory infection. (To learn about Pulmicort’s side effects, see this article.)
Interaction explained. After you take a dose of Pulmicort, an enzyme called CYP3A4 breaks down the medication so your body can get rid of it.
Certain medications can prevent CYP3A4 from working. These drugs are referred to as CYP3A4 inhibitors. Some, called strong CYP3A4 inhibitors, have a greater effect on stopping CYP3A4 from working. This can cause the Pulmicort levels in your body to rise, which may increase your risk of side effects from the medication.
Examples of CYP3A4 inhibitors. Here are some CYP3A4 inhibitors that may interact with Pulmicort:
- an antifungal drug called ketoconazole
- ritonavir and any treatment that contains it, such as:
- ritonavir/lopinavir (Kaletra)
- ritonavir/nirmatrelvir (Paxlovid)
- an antibiotic medication called clarithromycin
- the antidepressant nefazodone
- duvelisib (Copiktra), which is prescribed to treat certain types of leukemia
Steps you or your doctor may take. Your doctor can advise you on the risks and benefits of taking a CYP3A4 inhibitor with Pulmicort. They may:
- Prescribe these medications together, but monitor you closely for side effects of Pulmicort. In this case, they may suggest a lower dose of Pulmicort or the other medication.
- Suggest a treatment other than the CYP3A4 inhibitor.
- Suggest a treatment other than Pulmicort.
If you have questions about CYP3A4 inhibitors and Pulmicort, talk with your doctor.
Pulmicort may interact with the medication desmopressin (DDVAP, Nocdurna), which is prescribed for several conditions, such as nocturia. With this condition, the body makes too much urine at night.
Interaction result. Using Pulmicort in combination with desmopressin can increase the risk of side effects of desmopressin. Examples include low blood sodium levels.
Interaction explained. On its own, desmopressin can cause low blood sodium levels. In rare cases, this side effect can be severe and possibly life threatening. Using Pulmicort with desmopressin can increase your risk of low blood sodium levels.
Steps you or your doctor may take. Due to this risk, doctors typically won’t prescribe Pulmicort and desmopressin together. Instead, they’ll likely suggest a different treatment for either Pulmicort or desmopressin.
Interaction result. Using Pulmicort in combination with vigabatrin can increase the risk of eye-related side effects with Pulmicort and vigabatrin. (To learn about the side effects of Pulmicort, see this article.)
Interaction explained. In rare cases, corticosteroids such as Pulmicort can cause cataracts or glaucoma. In certain cases, vigabatrin can cause permanent vision loss. Using these medications together can increase your risk of eye-related side effects from either medication, but especially from vigabatrin.
Steps you or your doctor may take. Due to this risk, doctors typically won’t prescribe vigabatrin and Pulmicort together. Instead, they can recommend treatments other than vigabatrin or Pulmicort.
Pulmicort may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Pulmicort.
Pulmicort interactions with supplements
It’s possible for drugs to interact with supplements such as vitamins and herbs. Below is more information about Pulmicort interactions with herbal supplements.
Pulmicort interactions with herbs
The herbal supplement St. John’s wort may interact with Pulmicort.
Similar to certain medications described above, St. John’s wort can affect the CYP3A4 enzyme.* Specifically, St. John’s wort can cause your body to make more of the enzyme. This can lower Pulmicort levels in your body, causing the drug to not work as well as usual.
If you’re taking St. John’s wort, talk with your doctor about the risks and benefits of taking it with Pulmicort. Your doctor may prescribe an increased dose of Pulmicort. Or they can suggest treatments other than St. John’s wort that may be safer choices with Pulmicort.
* To learn more about the CYP3A4 enzyme, see “Drug interactions in depth” above.
Pulmicort and vitamins
There are no specific reports of vitamins interacting with Pulmicort Flexhaler or Pulmicort Respules. However, it’s possible that interactions with vitamins could be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Pulmicort.
Pulmicort interactions with food
Grapefruit and grapefruit juice may interact with Pulmicort.
Like certain medications described above, grapefruit can affect the CYP3A4 enzyme.* Specifically, grapefruit may prevent CYP3A4 from working, which could increase Pulmicort levels in your body. This could increase your risk of side effects with Pulmicort. (To learn about the side effects of Pulmicort, see this article.)
If you consume grapefruit or grapefruit juice, be sure to let your doctor know before you start using Pulmicort. They can advise you on the risks and benefits. Your doctor may prescribe a decreased dose of Pulmicort. Or they may suggest a treatment other than Pulmicort.
* To learn more about the CYP3A4 enzyme, see “Drug interactions in depth” above.
Pulmicort and vaccines
Pulmicort isn’t known to interact with any vaccines. If you’d like to learn more about receiving vaccines while using Pulmicort, talk with your pharmacist.
Pulmicort and lab tests
Pulmicort isn’t known to interact with lab tests. Your doctor can provide you with additional information about having lab tests during Pulmicort treatment.
Pulmicort interaction with cannabis or CBD
Cannabis (also called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Pulmicort Flexhaler and Pulmicort Respules. Cannabis may raise Pulmicort levels in your body, which could increase your risk of side effects. To learn about the side effects of Pulmicort, see this article.
Before you start treatment with Pulmicort, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions and other factors may increase the risk of interactions with Pulmicort. Before you start Pulmicort treatment, be sure to talk with your doctor about your health history. Pulmicort may not be the right option if you have certain medical conditions or other factors affecting your health.
Health conditions or factors that might interact with Pulmicort include the following.
Systemic corticosteroid use. Before starting Pulmicort treatment, tell your doctor if you’re taking or recently took a type of drug called a systemic corticosteroid.
In some cases, suddenly stopping systemic corticosteroid treatment can affect the body’s response to stressful situations, such as surgery or trauma. To help maintain your body’s ability to respond to stress, your doctor may have you take an oral corticosteroid along with Pulmicort. They’ll likely taper your use of the oral corticosteroid over time. (This means your doctor will slowly reduce the dose.) They can tell you more about a treatment plan that’s right for you.
Allergic reaction to Pulmicort or any of its ingredients. If you’ve had an allergic reaction to Pulmicort or any of its ingredients, your doctor will likely not prescribe Pulmicort. To learn more, see “When to avoid Pulmicort” above.
Milk allergy. If you have a severe milk allergy, your doctor will likely not prescribe Pulmicort Flexhaler. To learn more, see “When to avoid Pulmicort” above.
Tuberculosis. If you have active tuberculosis (TB), your doctor will likely recommend treating it before prescribing Pulmicort. (“Active” means you have symptoms.)
If you’ve been exposed to TB in the past, be sure to let your doctor know before you start using Pulmicort. It’s possible for TB to remain inactive in your body for many years, and using Pulmicort could cause the infection to become active again. This is because Pulmicort can weaken your immune system. Your doctor can provide more information on how they’ll manage your TB before prescribing Pulmicort.
Untreated infection. Pulmicort can weaken your immune system and make it harder to treat an infection. This could result in the infection becoming serious. Your doctor will likely want to treat any infection you have before prescribing Pulmicort.
Ocular herpes. Because Pulmicort can weaken your immune system, using the medication may cause ocular herpes to flare up if it’s already inside your body. If your doctor prescribes Pulmicort, they may recommend that you take an antiviral medication to help prevent ocular herpes flares.
Not being immunized for measles or chickenpox. Pulmicort can weaken your immune system. So if you get measles or chickenpox during your treatment, these infections can be more serious. If you haven’t been immunized against measles or chickenpox, while using Pulmicort it’s important that you avoid anyone who has these infections. You should immediately talk with your doctor if you come into contact with someone who has measles or chickenpox.
Weak bones, including osteoporosis. Using Pulmicort long term can weaken your bones, which could increase your risk of bone fractures. If your doctor prescribes Pulmicort, in some situations they may advise you to take a calcium and vitamin D supplement. These situations include having weak bones (such as osteoporosis) and being told that you’re at risk of weak bones.
Eye problems, such as glaucoma or cataracts. Using Pulmicort long term may worsen eye problems such as cataracts or glaucoma. Your doctor may suggest having frequent eye exams if they decide to prescribe Pulmicort.
Liver problems. Your liver helps break down Pulmicort after you take a dose. If you have liver problems, such as cirrhosis, your liver may not break down Pulmicort as well as usual. This could cause Pulmicort levels to rise in your body, which could increase your risk of side effects.* If you have liver problems and your doctor prescribes Pulmicort, they may monitor you more closely.
Pregnancy. Current guidelines suggest that the use of inhaled corticosteroids such as Pulmicort should not be stopped during pregnancy. Be sure to talk with your doctor about the benefits and risks of using Pulmicort while pregnant.
Breastfeeding. There hasn’t been research on how Pulmicort affects breast milk or children who are breastfed. If you’re breastfeeding or considering it, talk with your doctor before using Pulmicort.
* To learn about the side effects of Pulmicort, see this article.
Here are some frequently asked questions about Pulmicort’s interactions and their answers.
Can I use Pulmicort and Symbicort together?
Your doctor will likely not prescribe Pulmicort and Symbicort together. Both of these drugs contain budesonide.* Because of this, it’s possible that using Pulmicort and Symbicort could cause an overdose of either medication.
Also, both medications are prescribed as long-term treatments for asthma. There’s no known benefit to using these medications together.
If you have questions about other inhalers and whether they’re safe to use with Pulmicort, talk with your pharmacist or doctor.
* Symbicort also contains formoterol.
Is it safe to use Nasonex if I’m using Pulmicort, or do these medications interact?
It’s believed that it’s safe to use mometasone (Nasonex) during Pulmicort treatment.
Nasonex is a nasal spray used to help prevent and treat seasonal allergy symptoms such as a runny nose. Like budesonide (the active drug in Pulmicort), mometasone is a type of drug called a corticosteroid. Your body usually doesn’t absorb corticosteroids when they’re in nasal spray form. This is because the drug stays mostly in your nasal passages. As a result, nasal sprays such as Nasonex aren’t expected to interact with Pulmicort.
Your doctor and pharmacist can help answer other questions you may have about Nasonex and Pulmicort.
Do Pulmicort and Atrovent HFA interact?
No. The active drug in Atrovent HFA (ipratropium bromide) isn’t known to interact with Pulmicort.
Atrovent HFA is approved to treat chronic obstructive pulmonary disease (COPD). Guidelines recommend using ipratropiumbromide to treat asthma flare-ups that require emergency care. Pulmicort is for everyday use in treating asthma, not for emergency flare-ups.
If you have additional questions about Pulmicort and Atrovent HFA, talk with your pharmacist or doctor.
Can I mix Pulmicort Respules with other nebulized drugs, such as albuterol?
Possibly. Pulmicort Respules are liquid-filled containers that are used with a nebulizer. (A nebulizer is a machine that turns a liquid into a mist that you inhale.)
Albuterol is a drug commonly used to treat asthma. Albuterol comes in several forms, including liquid-filled containers that are used with a nebulizer.
A nebulizer treatment typically takes 10 to 15 minutes. People taking more than one nebulized drug may be curious about mixing these medications together in order to save time.
Some research suggests that budesonide (the active drug in Pulmicort Respules) is safe to mix with albuterol. However, Pulmicort’s manufacturer recommends administering Pulmicort Respules separately from other nebulized drugs.
If your child is taking Pulmicort, you can talk with their doctor to see if they recommend mixing or separating nebulizer treatments. (Pulmicort Respules are approved for use in children ages 1 to 8 years.)
You can take certain steps to help prevent interactions with Pulmicort. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:
- Let them know if you drink alcohol or take cannabis.
- Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
- Create a
medication list, which your doctor and pharmacist can help you fill out.
It’s also important to read Pulmicort’s label and other
You can also help prevent interactions with Pulmicort by using it exactly as your doctor prescribes.
Besides learning about interactions, you may want to find out more about Pulmicort. These resources might help:
- Overview of Pulmicort. For a general overview of Pulmicort, you can see this article.
- Side effects. If you’re interested in the side effects of Pulmicort, see this article. Another option is to refer to the prescribing information for Pulmicort Flexhaler and Pulmicort Respules.
- Dosage specifics. To learn about the dosage of Pulmicort, read this article.
- Drug comparison. Learn how Pulmicort compares with Symbicort and Flovent.
- Facts about your condition. To learn more about asthma, see our asthma and allergies hub.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.