Breztri Aerosphere Drug Interactions: What to Avoid and What to Tell Your Doctor

Breztri Aerosphere contains three active medications — budesonide, glycopyrrolate, and formoterol fumarate — each of which can interact with other drugs you may be taking. Because drug interactions can reduce Breztri's effectiveness or increase the risk of serious side effects, it's critical to tell your doctor and pharmacist about every medication you take before starting Breztri. This guide covers the most important drug interactions and what you need to know.

Most Important: What to AVOID While Taking Breztri

1. Other LABA-Containing Medications — Major Interaction

Do not use Breztri with any other inhaled medication that contains a long-acting beta2-agonist (LABA). Examples include:

Salmeterol (Serevent, Advair)

Formoterol (Foradil, Perforomist, Symbicort)

Indacaterol (Arcapta Neohaler)

Olodaterol (Striverdi Respimat, Stiolto Respimat)

Vilanterol (Anoro Ellipta, Breo Ellipta, Trelegy Ellipta)

Using two LABA-containing inhalers simultaneously can cause a LABA overdose, leading to serious cardiovascular effects including dangerous arrhythmias, excessive increases in heart rate and blood pressure, and potentially life-threatening events.

2. Other Anticholinergic Medications — Major Interaction

Do not use Breztri with other inhaled anticholinergic (muscarinic antagonist) medications. Examples include:

Tiotropium (Spiriva Respimat, Spiriva HandiHaler)

Umeclidinium (Incruse Ellipta, Anoro Ellipta, Trelegy Ellipta)

Aclidinium (Tudorza Pressair)

Revefenacin (Yupelri)

The additive anticholinergic effect can worsen side effects: urinary retention, dry mouth, constipation, blurred vision, and in severe cases, increased intraocular pressure leading to acute glaucoma attack.

3. Beta-Blockers — Significant Interaction

Beta-blocking medications (used for heart conditions, hypertension, or migraine) can block the bronchodilating effects of formoterol, reducing Breztri's effectiveness. In patients with COPD or asthma, this can trigger or worsen bronchospasm. Common beta-blockers include:

Metoprolol (Lopressor, Toprol-XL)

Atenolol (Tenormin)

Propranolol (Inderal)

Carvedilol (Coreg)

If you need a beta-blocker for cardiac reasons, ask your cardiologist and pulmonologist to coordinate — cardioselective beta-blockers (like metoprolol) may be used with caution and careful monitoring.

4. MAOIs (Monoamine Oxidase Inhibitors) — Major Interaction

MAOIs can potentiate the cardiovascular effects of formoterol fumarate, potentially causing dangerous increases in heart rate and blood pressure. Do not use Breztri within 14 days (2 weeks) of stopping an MAOI. MAOIs used for depression or Parkinson's disease include phenelzine, tranylcypromine, and selegiline.

5. Tricyclic Antidepressants — Significant Interaction

Like MAOIs, tricyclic antidepressants (TCAs) can potentiate the cardiovascular effects of formoterol. Examples include amitriptyline (Elavil), nortriptyline (Pamelor), and protriptyline. Tell your doctor about any TCA use even if it was prescribed for something other than depression, such as neuropathic pain or migraine prevention.

6. Strong CYP3A4 Inhibitors — Moderate to Major Interaction

Budesonide is metabolized by the CYP3A4 liver enzyme. Drugs that strongly inhibit CYP3A4 slow the breakdown of budesonide, causing its levels to build up in the body. This increases the risk of systemic corticosteroid side effects (such as adrenal suppression). Strong CYP3A4 inhibitors to be cautious with include:

Ketoconazole (antifungal)

Ritonavir, atazanavir (HIV medications)

Clarithromycin (antibiotic)

Itraconazole, nefazodone, telithromycin

7. Diuretics (Water Pills) — Moderate Interaction

Formoterol can cause a drop in blood potassium levels (hypokalemia) and ECG changes. Non-potassium-sparing diuretics (such as furosemide/Lasix or hydrochlorothiazide) can worsen hypokalemia. If you're on a diuretic, your doctor may want to monitor your potassium levels while you use Breztri.

What to Tell Your Doctor Before Starting Breztri

Before your first Breztri prescription is filled, give your doctor or pharmacist a complete list of all:

Prescription medications (especially other inhalers, heart medications, antidepressants, antifungals, and HIV drugs)

Over-the-counter medications (including decongestants containing beta-agonist-like stimulants)

Vitamins and supplements (some herbal products affect CYP3A4)

Drug interactions can sometimes be confused with direct medication side effects. For a full rundown of Breztri's side effects and when to call your doctor, see our guide on Breztri side effects.

Once you have your Breztri prescription, use medfinder to locate which pharmacies near you currently have it in stock.