Inhaled corticosteroid use in HIV‐positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management
Open Access
- 16 April 2013
- journal article
- review article
- Published by Wiley in HIV Medicine
- Vol. 14 (9), 519-529
- https://doi.org/10.1111/hiv.12039
Abstract
As a consequence of inhibition of the hepatic cytochrome P450 3A4 isozyme, treatment with 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 and iatrogenic Cushing's syndrome (with symptoms such as rapid weight gain, obesity, facial hirsutism and swelling), 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 suggest options for the clinical management of HIV‐positive patients requiring treatment with protease inhibitors and inhaled or intranasal corticosteroids.Keywords
This publication has 52 references indexed in Scilit:
- Hypercortisolism Caused by Ritonavir Associated Inhibition of CYP 3A4 Under Inhalative Glucocorticoid Therapy. 2 Case Reports and a Review of the LiteratureExperimental and Clinical Endocrinology & Diabetes, 2012
- DrugBank 3.0: a comprehensive resource for 'Omics' research on drugsNucleic Acids Research, 2010
- Iatrogenic Cushing's Syndrome due to Coadministration of Ritonavir and Inhaled Budesonide in an Asthmatic Human Immunodeficiency Virus Infected PatientJournal of Asthma, 2010
- Human receptor kinetics and lung tissue retention of the enhanced-affinity glucocorticoid fluticasone furoateRespiratory Research, 2007
- Cushing Syndrome and Severe Adrenal Suppression Caused by Fluticasone and Protease Inhibitor Combination in an HIV-Infected AdolescentAIDS Patient Care and STDs, 2007
- Ritonavir–Fluticasone Interaction Causing Cushing Syndrome in HIV-Infected Children and AdolescentsThe Pediatric Infectious Disease Journal, 2006
- Ritonavir and fluticasone: Beware of this potentially fatal combinationThe Journal of Pediatrics, 2006
- Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasoneThe Journal of Pediatrics, 2006
- Cushing's syndrome without excess cortisolBMJ, 2006
- Hypothalamic-Pituitary-Adrenal Axis Suppression and Inhaled Corticosteroid TherapyNeuroimmunomodulation, 1998