Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasone

Johnson, Susan R.; Marion, Alicia A.; Vrchoticky, Teri; Emmanuel, Patricia; Luján-Zilbermann, Jorge

doi:10.1016/j.jpeds.2005.11.034

Cited by 43 publications

(36 citation statements)

References 11 publications

(11 reference statements)

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“…Long-term growth studies in children using fluticasone, mometasone and budesonide have reassuring safety data, unlike beclomethasone [87][88][89][90][91]. Concomitant treatment with CYP3A inhibitors such as itraconazole or ritonivir may increase systemic bioavailability of intranasal corticosteroids [92,93].…”

Section: Topical Intranasal Corticosteroidsmentioning

confidence: 99%

BSACI guidelines for the management of allergic and non‐allergic rhinitis

Scadding

Durham

Mirakian

et al. 2007

Clin Experimental Allergy

348

292

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SummaryThis guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.

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Section: Topical Intranasal Corticosteroidsmentioning

confidence: 99%

BSACI guidelines for the management of allergic and non‐allergic rhinitis

Scadding

Durham

Mirakian

et al. 2007

Clin Experimental Allergy

348

292

View full text Add to dashboard Cite

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“…[7][8][9][10][11][12][13][14] In a recent literature review, Epperla et al reported a total of 37 cases of iatrogenic Cushing's syndrome and adrenal suppression as a result of concomitant use of fluticasone and ritonavir in which the time between co-administration and the development of symptoms ranged from two weeks to two years. 7 Another review showed that it took between two weeks and 12 months for patients to experience a complete resolution of symptoms after either drug was discontinued.…”

Section: Discussionmentioning

confidence: 99%

Secondary Adrenal Insufficiency Due to the Co-Administration of Ritonavir and Inhaled Fluticasone Propionate: Case report

Al-Maqbali

Kamble

Al-Qassabi

et al. 2017

SQUMJ

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Ritonavir is a powerful inhibitor of the cytochrome P450 3A4 (CYP3A4) isoenzyme. It is used as a pharmaceutical enhancer in the management of HIV-positive patients. However, when co-administered with other drugs that are metabolised via the CYP3A4 pathway, ritonavir can potentially cause serious drug-drug interactions. Inhaled fluticasone propionate, which is used to treat asthma and chronic obstructive airway disease, is particularly prone to such interactions due to its physiological attributes. We report a HIV-positive 48-year-old male patient who presented to Al Nahdha Hospital, Muscat, Oman, in 2012 with weight loss, generalised weakness and fatigue and diagnosed with secondary adrenal insufficiency as a result of concomitant ritonavir and inhaled fluticasone.

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“…Concomitant treatment with CYP3A inhibitors such as itraconazole or ritonivir may increase the systemic CRS, chronic rhinosinusitis. bioavailability of intra-nasal corticosteroids (INS) [63,64].…”

Section: Place In Therapymentioning

confidence: 99%

BSACI guidelines for the management of rhinosinusitis and nasal polyposis

Scadding

Durham

Mirakian

et al. 2007

Clin Experimental Allergy

206

222

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SummaryThis guidance for the management of patients with rhinosinusitis and nasal polyposis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The recommendations are based on evidence and expert opinion and are evidence graded. These guidelines are for the benefit of both adult physicians and paediatricians treating allergic conditions. Rhinosinusitis implies inflammation of the nose and sinuses which may or may not have an infective component and includes nasal polyposis. Acute rhinosinusitis lasts up to 12 weeks and resolves completely. Chronic rhinosinusitis persists over 12 weeks and may involve acute exacerbations. Rhinosinusitis is common, affecting around 15% of the population and causes significant reduction in quality of life. The diagnosis is based largely on symptoms with confirmation by nasendoscopy. Computerized tomography scans and magnetic resonance imaging are abnormal in approximately one third of the population so are not recommended for routine diagnosis but should be reserved for those with acute complications, diagnostic uncertainty or failed medical therapy. Underlying conditions such as immune deficiency, Wegener's granulomatosis, Churg-Strauss syndrome, aspirin hypersensitivity and allergic fungal sinusitis may present as rhinosinusitis. There are few good quality trials in this area but the available evidence suggests that treatment is primarily medical, involving douching, corticosteroids, antibiotics, anti-leukotrienes, and anti-histamines. Endoscopic sinus surgery should be considered for complications, anatomical variations causing local obstruction, allergic fungal disease or patients who remain very symptomatic despite medical treatment. Further well conducted trials in clearly defined patient groups are needed to improve management.

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Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasone

Cited by 43 publications

References 11 publications

BSACI guidelines for the management of allergic and non‐allergic rhinitis

BSACI guidelines for the management of allergic and non‐allergic rhinitis

Secondary Adrenal Insufficiency Due to the Co-Administration of Ritonavir and Inhaled Fluticasone Propionate: Case report

BSACI guidelines for the management of rhinosinusitis and nasal polyposis

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