Amiodarone × Budesonide

Amiodarone inhibits CYP3A4 — the enzyme responsible for budesonide metabolism. Oral budesonide levels may rise, increasing iatrogenic hypercortisolism risk in long-term therapy. Inhaled budesonide is minimally absorbed — the effect is weaker.

On long-term therapy: moon face, weight gain with fat redistribution, skin thinning, acne, muscle weakness, mood disturbance, hyperglycaemia.

For inhaled budesonide (Symbicort, Pulmicort) plus amiodarone, no adjustment needed. On oral budesonide (Cortiment, Entocort) over 8 weeks, assess for hypercortisolism and consider dose reduction or switching to mesalazine (in Crohn's disease). Amiodarone alternative in atrial fibrillation: dronedarone (no CYP3A4 effect).