Moderate
Budesonide × carvedilol
Inhaled corticosteroids (ICS)×Alpha and beta blocker (non-selective β + α1)
Mechanism
Systemic budesonide retains sodium and water, blunting the beta-blocker's antihypertensive effect. Inhaled budesonide does not clinically affect BP.
Symptoms
On long-term systemic therapy: return or rise of blood pressure, leg oedema.
Management
For short systemic budesonide courses, no specific adjustment needed. For long-term therapy, check BP weekly in the first month. If BP rises, increase carvedilol or add an ACE inhibitor. Inhaled budesonide with carvedilol is unproblematic.