Drug General Information (ID: DDI3802JPN)
Drug Name			Budesonide		Drug Info		Salsalate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Antiinflammatory Agents
Structure

Mechanism of Budesonide-Salsalate Interaction (Severity Level: Moderate)
Increased risk of GI mucosal injury/bleeding risk Click to Show/Hide Mechanism Graph
Drug Name		Budesonide				Salsalate
Mechanism		GI mucosal injury/bleeding risk				GI mucosal injury/bleeding risk
Key Mechanism Factor 1
		Factor Name		Gastrointestinal toxicity
		Factor Description		The risk and severity of gastrointestinal toxicity, including inflammation, bleeding, ulceration, and perforation, increases when drugs with gastrointestinal mucosal irritant effects are combined.
Mechanism Description		Increased risk of GI mucosal injury/bleeding risk by the combination of Budesonide and Salsalate

Recommended Action
Management		Patients treated concomitantly with a corticosteroid may require higher dosages of salicylates or salicylate-like drugs. Pharmacologic response to these agents should be monitored more closely whenever a corticosteroid is added to or withdrawn from therapy in patients stabilized on their existing salicylate regimen, and the salicylate dosage adjusted as necessary. During concomitant therapy, patients should be advised to take the medications with food and to immediately report signs and symptoms of GI ulceration and bleeding such as severe abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry stools. The selective use of prophylactic anti-ulcer therapy (e.g., antacids, H2-antagonists) may be appropriate, particularly in patients with a prior history of peptic ulcer disease or GI bleeding and in elderly and debilitated patients.

References
1	Baer PA, Shore A, Ikeman RL "Transient fall in serum salicylate levels following intraarticular injection of steroid in patients with rheumatoid arthritis." Arthritis Rheum 30 (1987): 345-7. [PMID: 3566826]
2	Edelman J, Potter JM, Hackett LP "The effect of intra-articular steroids on plasma salicylate concentrations." Br J Clin Pharmacol 21 (1986): 301-7. [PMID: 3485989]
3	Hansen RA, Tu W, Wang J, Ambuehl R, McDonald CJ, Murray MD "Risk of adverse gastrointestinal events from inhaled corticosteroids." Pharmacotherapy 28 (2008): 1325-34. [PMID: 18956992]
4	Koren G, Roifman C, Gelfand E, Lavi S, Suria D, Stein L "Corticosteroids-salicylate interaction in a case of juvenile rheumatoid arthritis." Ther Drug Monit 9 (1987): 177-9. [PMID: 3617157]
5	Piper JM, Ray WA, Daugherty JR, Griffin MR "Corticosteroid use and peptic ulcer disease: role of nonsteroidal ani-inflammatory drugs." Ann Intern Med 114 (1991): 735-40. [PMID: 2012355]