Moderate
Budesonide × fluvoxamine
Inhaled corticosteroids (ICS)×SSRI
Mechanism
Fluvoxamine is a CYP3A4 inhibitor; budesonide is a CYP3A4 substrate. Oral budesonide AUC may rise, increasing hypercortisolism risk in long-term therapy. Inhaled budesonide is minimally absorbed — the effect is weaker.
Symptoms
On long-term therapy: moon face, weight gain with fat redistribution, skin thinning, acne, muscle weakness, mood disturbance, hyperglycaemia.
Management
For inhaled budesonide and fluvoxamine, no adjustment needed. On oral budesonide over 8 weeks, assess for hypercortisolism and consider antidepressant alternatives — sertraline or escitalopram (minimal CYP3A4 effect).
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.