Adrenal insufficiency, be aware of drug interactions!

Thijs, Elke; Wierckx, Katrien; Vandecasteele, Stefaan; Bruel, Annick Van den

doi:10.1530/edm-19-0062

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Patients with adrenal TB are usually treated with standard quadruple antitubercular treatment (such as isoniazid, rifampicin, pyrazinamide, and ethambutol)[ 18 - 20 ] for nearly 12 mo or longer. Adverse reactions to anti-TB drugs and their interactions with corticosteroids that are administered for replacement therapy remain challenging[ 21 , 22 ]. Firstly, rifampicin increases cortisol catabolism while isoniazid produces increased levels of cortisol via an opposite effect on the enzyme activity 6-Bhydroxylase; secondly, hepatitis, induced by isoniazid and worsened by rifampicin, leads to failure of 11-B-oxo-reductase, which converts cortisone to cortisol; and finally, tuberculous Addison’s disease might require increased amounts of hydrocortisone due to rifampicin administration[ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Unilateral adrenal tuberculosis whose computed tomography imaging characteristics mimic a malignant tumor: A case report

Liu¹,

Tang²,

An³

et al. 2022

WJCC

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BACKGROUND Adrenal tuberculosis usually presents with bilateral involvement. It has special characteristics in computed tomography (CT) images, such as small size, low attenuation in the center, and peripheral rim enhancement, which differ from those of primary tumors. CASE SUMMARY A 42-year-old female presented to the hospital with low back pain. She had been diagnosed with hypertension as well as pulmonary and cerebral tuberculosis but denied having any fever, fatigue, anorexia, night sweats, cough, or weight loss. Abdominal CT revealed an irregular 6.0 cm × 4.5 cm mass with uneven density in the right adrenal gland, while the left adrenal gland was normal. No abnormalities were observed in plasma total cortisol (8 am), adrenocorticotropic hormone, aldosterone/renin ratio, blood catecholamines, or urine catecholamines. A fine-needle aspiration biopsy of the right adrenal gland provided evidence of tuberculosis. After three years of anti-tuberculosis treatments, the large mass in the right adrenal gland was reduced to a slight enlargement. CONCLUSION This is a case of unilateral adrenal tuberculosis with CT imaging characteristics mimicking those of a malignant tumor. Extended anti-tuberculosis therapy is recommended in such cases.

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Section: Discussionmentioning

confidence: 99%

Unilateral adrenal tuberculosis whose computed tomography imaging characteristics mimic a malignant tumor: A case report

Liu¹,

Tang²,

An³

et al. 2022

WJCC

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“… 26 , 108 As CYP3A4 and P-gp are major pharmacokinetics determinants of lopinavir/ritonavir, dexamethasone, hydrocortisone, methylprednisolone, ruxolitinib, losartan, apixaban, dabigatran, rivaroxaban, edoxaban and simvastatin, CYP3A4 and P-gp induction could increase the metabolism of these drugs and consequently reduces its plasma concentration. 109 – 123 Valsartan is a substrate of efflux transporters P-gp (N.S = −1861.07) and MRP (multidrug resistance-associated protein) and uptake transporter OATP (organic anion transporter polypeptide). Therefore, co-administration with rifampin, an inducer of all the above transporters, may increase valsartan exposure.…”

Section: Discussionmentioning

confidence: 99%

Prediction of potential drug interactions between repurposed COVID-19 and antitubercular drugs: an integrational approach of drug information software and computational techniques data

Thomas

Birangal

Ray

et al. 2021

Therapeutic Advances in Drug Safety

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Introduction: Tuberculosis is a major respiratory disease globally with a higher prevalence in Asian and African countries than rest of the world. With a larger population of tuberculosis patients anticipated to be co-infected with COVID-19 infection, an ongoing pandemic, identifying, preventing and managing drug–drug interactions is inevitable for maximizing patient benefits for the current repurposed COVID-19 and antitubercular drugs. Methods: We assessed the potential drug–drug interactions between repurposed COVID-19 drugs and antitubercular drugs using the drug interaction checker of IBM Micromedex®. Extensive computational studies were performed at a molecular level to validate and understand the drug–drug interactions found from the Micromedex drug interaction checker database at a molecular level. The integrated knowledge derived from Micromedex and computational data was collated and curated for predicting potential drug–drug interactions between repurposed COVID-19 and antitubercular drugs. Results: A total of 91 potential drug–drug interactions along with their severity and level of documentation were identified from Micromedex between repurposed COVID-19 drugs and antitubercular drugs. We identified 47 pharmacodynamic, 42 pharmacokinetic and 2 unknown DDIs. The majority of our molecular modelling results were in line with drug–drug interaction data obtained from the drug information software. QT prolongation was identified as the most common type of pharmacodynamic drug–drug interaction, whereas drug–drug interactions associated with cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) inhibition and induction were identified as the frequent pharmacokinetic drug–drug interactions. The results suggest antitubercular drugs, particularly rifampin and second-line agents, warrant high alert and monitoring while prescribing with the repurposed COVID-19 drugs. Conclusion: Predicting these potential drug–drug interactions, particularly related to CYP3A4, P-gp and the human Ether-à-go-go-Related Gene proteins, could be used in clinical settings for screening and management of drug–drug interactions for delivering safer chemotherapeutic tuberculosis and COVID-19 care. The current study provides an initial propulsion for further well-designed pharmacokinetic-pharmacodynamic-based drug–drug interaction studies. Plain Language Summary Introduction: Tuberculosis is a major respiratory disease globally with a higher prevalence in Asian and African countries than rest of the world. With a larger population of tuberculosis patients predicted to be infected with COVID-19 during this period, there is a higher risk for the occurrence of medication interactions between the medicines used for COVID-19 and tuberculosis. Hence, identifying and managing these interactions is vital to ensure the safety of patients undergoing COVID-19 and tuberculosis treatment simultaneously. Methods: We studied the major medication interactions that could likely happen between the various medicines that are currently given for COVID-19 and tuberculosis treatment using the medication interaction checker of a drug information software (Micromedex®). In addition, thorough molecular modelling was done to confirm and understand the interactions found from the medication interaction checker database using specific docking software. Molecular docking is a method that predicts the preferred orientation of one medicine molecule to a second molecule, when bound to each other to form a stable complex. Knowledge of the preferred orientation may be used to determine the strength of association or binding affinity between two medicines using scoring functions to determine the extent of the interactions between medicines. The combined knowledge from Micromedex and molecular modelling data was used to properly predict the potential medicine interactions between currently used COVID-19 and antitubercular medicines. Results: We found a total of 91 medication interactions from Micromedex. Majority of our molecular modelling findings matched with the interaction information obtained from the drug information software. QT prolongation, an abnormal heartbeat, was identified as one of the most common interactions. Our findings suggest that antitubercular medicines, mainly rifampin and second-line agents, suggest high alert and scrutiny while prescribing with the repurposed COVID-19 medicines. Conclusion: Our current study highlights the need for further well-designed studies confirming the current information for recommending safe prescribing in patients with both infections.

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Hydrocortisone/rifampicin interaction

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Adrenal insufficiency, be aware of drug interactions!

Cited by 4 publications

References 10 publications

Unilateral adrenal tuberculosis whose computed tomography imaging characteristics mimic a malignant tumor: A case report

Unilateral adrenal tuberculosis whose computed tomography imaging characteristics mimic a malignant tumor: A case report

Prediction of potential drug interactions between repurposed COVID-19 and antitubercular drugs: an integrational approach of drug information software and computational techniques data

Hydrocortisone/rifampicin interaction

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