Understanding Breo Ellipta Drug Interactions

If you take Breo Ellipta (fluticasone furoate/vilanterol), you need to know which other medications, supplements, and foods can interact with it. Some interactions can reduce Breo's effectiveness. Others can increase your risk of serious side effects.

This guide covers the most important interactions to watch for and what information your doctor needs from you.

How Drug Interactions Work with Breo

Breo Ellipta contains two active ingredients, and each one can interact with different substances:

• Fluticasone furoate (the corticosteroid) is broken down in your body by an enzyme called CYP3A4. Anything that blocks this enzyme can cause fluticasone to build up to higher levels in your body, increasing the risk of corticosteroid side effects.
• Vilanterol (the LABA/bronchodilator) affects your heart and nervous system. Medications that also stimulate your heart or affect potassium levels can amplify these effects.

Major Drug Interactions

These interactions are the most clinically significant and may require avoiding the combination or close monitoring:

Strong CYP3A4 Inhibitors

These medications block the enzyme that breaks down fluticasone, causing it to accumulate in your body. This can lead to Cushing's syndrome (excess cortisol) and adrenal suppression:

• Ketoconazole (Nizoral) — antifungal
• Itraconazole (Sporanox) — antifungal
• Ritonavir (Norvir) — HIV protease inhibitor
• Cobicistat (Tybost, also in Stribild and Genvoya) — HIV pharmacokinetic enhancer
• Clarithromycin (Biaxin) — antibiotic

If you need one of these medications, your doctor may choose an alternative to Breo or closely monitor you for signs of excess corticosteroid effects (weight gain, moon face, easy bruising, high blood sugar).

MAO Inhibitors and Tricyclic Antidepressants

These medications can potentiate the cardiovascular effects of vilanterol, increasing the risk of rapid heartbeat, elevated blood pressure, and arrhythmias:

• MAO inhibitors: Phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), selegiline (Emsam)
• Tricyclic antidepressants: Amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), imipramine (Tofranil)

If you take any of these, your doctor needs to weigh the risks carefully before prescribing Breo.

Beta-Blockers

Beta-blockers can block the bronchodilating effect of vilanterol and may cause severe bronchospasm in patients with asthma or COPD:

• Non-selective beta-blockers are the most dangerous: propranolol (Inderal), nadolol (Corgard), carvedilol (Coreg)
• Cardioselective beta-blockers like metoprolol (Lopressor) and atenolol (Tenormin) are somewhat safer but should still be used with caution

If you have asthma and need a beta-blocker for heart conditions, your doctor will typically choose a cardioselective one at the lowest effective dose.

Other Long-Acting Beta-Agonists (LABAs)

Do not use Breo with another LABA-containing product. Using two LABAs together increases the risk of cardiovascular side effects (rapid heart rate, arrhythmias) and overdose. This includes:

• Salmeterol (in Advair, Serevent)
• Formoterol (in Symbicort, Dulera, Perforomist)
• Olodaterol (in Stiolto Respimat)
• Indacaterol (in Arcapta, Utibron)

Moderate Drug Interactions

These interactions are less dangerous but still worth discussing with your doctor:

Non-Potassium-Sparing Diuretics

Loop diuretics like furosemide (Lasix) and thiazide diuretics like hydrochlorothiazide (HCTZ) can lower potassium levels. Since vilanterol can also lower potassium, the combination may worsen hypokalemia, which can cause muscle weakness, cramps, and heart rhythm changes.

QT-Prolonging Medications

Vilanterol may contribute to QT prolongation (a heart rhythm abnormality). Use caution if you also take medications known to prolong the QT interval, such as:

• Certain antibiotics (azithromycin, fluoroquinolones)
• Antiarrhythmics (amiodarone, sotalol)
• Some antipsychotics (haloperidol, ziprasidone)

Moderate CYP3A4 Inhibitors

These don't block CYP3A4 as strongly but may still increase fluticasone levels:

• Erythromycin — antibiotic
• Diltiazem (Cardizem) — calcium channel blocker
• Verapamil (Calan) — calcium channel blocker

Supplements and OTC Medications to Watch

Over-the-counter products can also interact with Breo:

• Decongestants containing pseudoephedrine or phenylephrine — These stimulate the cardiovascular system similarly to vilanterol and may increase heart rate and blood pressure.
• Caffeine pills or high-caffeine supplements — May add to the cardiac stimulation from vilanterol.
• Potassium-depleting supplements or laxatives — Can worsen the hypokalemia risk from vilanterol.
• St. John's Wort — A CYP3A4 inducer that could theoretically reduce fluticasone effectiveness (though the clinical impact for inhaled steroids is likely small).

Food and Drink Interactions

Grapefruit juice is a CYP3A4 inhibitor and could modestly increase fluticasone levels. However, because Breo is inhaled (not swallowed), the clinical significance is low. Most doctors don't restrict grapefruit with Breo, but it's worth mentioning if you drink it regularly.

There are no other significant food interactions with Breo Ellipta.

What to Tell Your Doctor

Before starting Breo, make sure your doctor knows about:

1. All prescription medications you take — especially antifungals, HIV medications, antibiotics, antidepressants, beta-blockers, and heart rhythm medications.
2. All over-the-counter medications — including cold medicines with decongestants, pain relievers, and allergy medications.
3. All supplements and herbal products — including St. John's Wort, caffeine supplements, and any potassium or electrolyte products.
4. Other inhalers — especially if any contain a LABA (long-acting bronchodilator). Your doctor needs to know so you don't accidentally double up.
5. Any heart conditions — arrhythmias, prolonged QT interval, heart failure, or high blood pressure.

Keeping your doctor and pharmacist fully informed is the best way to avoid dangerous interactions. If you're ever prescribed a new medication by a different doctor, remind them that you take Breo Ellipta.

Final Thoughts

Breo Ellipta is generally safe when used as directed, but its two active ingredients can interact with a variety of other medications. The most important interactions to avoid are strong CYP3A4 inhibitors (which can cause systemic steroid effects), other LABAs (which can cause cardiac overdose), and beta-blockers (which can block Breo's bronchodilating benefit).

When in doubt, ask your pharmacist to run an interaction check every time you start a new medication. And for more about Breo's safety profile, read our side effects guide.

Looking for Breo at your pharmacy? Search Medfinder to check local availability.