Moderate
Budesonide × clonidine
Inhaled corticosteroids (ICS)×Central α2-adrenergic agonist
Mechanism
Systemic budesonide retains sodium and water via mineralocorticoid effect, blunting clonidine'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 clonidine or add a diuretic. Inhaled budesonide with clonidine is unproblematic.