Drug interactions between inhaled corticosteroids and enzymatic inhibitors

Daveluy, Amélie; Raignoux, Cécile; Miremont-Salamé, Ghada; Girodet, Pierre‐Olivier; Moore, Nicholas; Haramburu, Françoise; Molimard, Mathiéu

doi:10.1007/s00228-009-0653-4

Cited by 43 publications

(25 citation statements)

References 17 publications

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“…By searching PubMed and the references of pertinent articles, and by contacting relevant drug companies, we identified 51 case reports published in English regarding adverse effects with the use of inhaled ( n = 45), intranasal ( n = 2), and combination inhaled and intranasal ( n = 4) corticosteroids and PIs (Table ) . Papers were published between the years 1999 and 2012.…”

Section: Case Reports On Corticosteroid−protease Inhibitor Drug−drug mentioning

confidence: 99%

Inhaled corticosteroid use in HIV‐positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management

2013

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Due to the inhibition of hepatic cytochrome P450 3A4 isozyme, HIV protease inhibitors can result in significant drug-drug interactions. One noteworthy interaction is between protease inhibitors and inhaled or intranasal corticosteroids. This interaction can result in adrenal insufficiency, iatrogenic Cushing’s syndrome (with symptoms such as rapid weight gain, obesity, facial hirsutism and swelling, etc.), as well as hypertension, osteoporosis, and decreased CD4+ cell count. In this paper, we review and unite pharmacokinetic data, case reports, and current research regarding this drug-drug interaction in order to provide options for the clinical management of HIV-positive patients requiring treatment with protease inhibitors and inhaled or intranasal corticosteroids.

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Section: Case Reports On Corticosteroid−protease Inhibitor Drug−drug mentioning

confidence: 99%

Inhaled corticosteroid use in HIV‐positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management

2013

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“…This is well demonstrated in a case series of 46 patients on inhaled steroids who developed adrenal insufficiency. Fifteen of the cases were possibly due to a drug interaction with known cytochrome p450 inhibitors, including itraconazole, ritonavir, verapamil, and diltiazem [15]. Other known inhibitors include etomidate, diltiazem, and grapefruit juice.…”

Section: Discussionmentioning

confidence: 99%

“…For evaluation of at-risk patients, the low-dose (0.5–1 μ g) ACTH stimulation test is thought to be more sensitive for diagnosing secondary adrenal suppression, as the usual 250 μ g dose is supraphysiologic and might lead to false negative results. However, some studies do not support the superiority of one test over the other, particularly as both may lead to false negative results [15]. …”

Section: Discussionmentioning

confidence: 99%

Acute Adrenal Crisis in an Asthmatic Child Treated with Inhaled Fluticasone Proprionate

Santiago

Ratzan

2010

International Journal of Pediatric Endocrinology

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Adrenal suppression secondary to prolonged inhaled corticosteroid use is usually limited to biochemical abnormalities, with no obvious clinical effects. Acute adrenal crisis is much rarer event but has been reported with increasing frequency. We report a case of a 7-year-old asthmatic child who presented with an acute history of lethargy after a respiratory infection. He was maintained on 220 μg/day of fluticasone propionate for several years. Initial evaluation revealed severe adrenal suppression, with undetectable cortisol levels and minimal response after stimulation with ACTH. After fluticasone was discontinued, a gradual recovery of the adrenal axis was seen. This case shows that acute adrenal crisis may be a consequence even at the usual prescribed doses, stressing the importance of using the lowest dose of inhaled steroids needed to control symptoms and having an increased awareness of this complication.

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“…In this real-life scenario it becomes clinically important to prevent (or recognize) the side effects which are relative to the pharmacodynamic and pharmacokinetic properties of specific ICSs, and to a variable extent influenced by the interaction with other concomitant pharmacological classes [63]. In their clinical practice, clinicians should therefore be aware of the main determinants of drug interactions, such as first pass metabolism and bioavailability.…”

Section: Pneumoniamentioning

confidence: 99%

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

et al. 2015

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Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and longterm use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly. Key PointsAsthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders of the airways. The pharmacological management of these chronic diseases is based on persistent and long-term use of inhaled corticosteroids (ICSs).Asthma and COPD are among the most common chronic diseases in clinical settings, and physicians are expected to diagnose and manage those diseases in the geriatric population on a daily basis. The management of chronic obstructive respiratory diseases in the geriatric population is complicated by the increased occurrence of comorbidities and associated treatment, and by age-associated physiological and structural changes of the lung.The chronic use of ICSs in the elderly is associated with the increased risk of local and systemic side effects such as candidiasis, cataract, glaucoma, diabetes mellitus, bone fractures, and pneumonia. Physicians should be aware of this in order to select those patients in whom the benefits will outweigh the risks.The online version of the original article can be found under

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Drug interactions between inhaled corticosteroids and enzymatic inhibitors

Cited by 43 publications

References 17 publications

Inhaled corticosteroid use in HIV‐positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management

Inhaled corticosteroid use in HIV‐positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management

Acute Adrenal Crisis in an Asthmatic Child Treated with Inhaled Fluticasone Proprionate

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

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