Abstract
Two CF patients developed Cushing's syndrome during administration of inhaled budesonide (400 microg/d) with oral itraconazole in one and with clarithromycin in the other patient. Clinical features appeared respectively after 2 and 6 weeks of drug co-administration, with prolonged adrenal suppression, and a slow recovery after ceasing the drugs. Inhibitors of the cytochrome P450 interfere with the metabolism of corticosteroids. Combination of these drugs even with moderate doses of budesonide should be closely monitored.
MeSH terms
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Administration, Inhalation
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Adult
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Anti-Bacterial Agents / adverse effects
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Anti-Inflammatory Agents / administration & dosage
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Anti-Inflammatory Agents / adverse effects*
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Anti-Inflammatory Agents / metabolism
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Antifungal Agents / adverse effects
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Aspergillosis, Allergic Bronchopulmonary / drug therapy
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Aspergillus fumigatus
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Bronchodilator Agents / administration & dosage
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Bronchodilator Agents / adverse effects*
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Bronchodilator Agents / metabolism
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Budesonide / administration & dosage
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Budesonide / adverse effects*
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Budesonide / metabolism
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Clarithromycin / adverse effects
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Cushing Syndrome / chemically induced*
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Cushing Syndrome / diagnosis
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Cystic Fibrosis / complications*
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Cystic Fibrosis / metabolism
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Cytochrome P-450 Enzyme Inhibitors
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Cytochrome P-450 Enzyme System / drug effects*
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Drug Synergism
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Drug Therapy, Combination
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Escherichia coli Infections / drug therapy
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Fatal Outcome
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Female
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Humans
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Iatrogenic Disease
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Infant, Newborn
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Itraconazole / adverse effects
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Lung Diseases / diagnosis
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Lung Diseases / drug therapy*
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Lung Diseases / etiology
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Male
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Mycobacterium Infections, Nontuberculous / drug therapy
Substances
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Anti-Bacterial Agents
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Anti-Inflammatory Agents
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Antifungal Agents
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Bronchodilator Agents
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Cytochrome P-450 Enzyme Inhibitors
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Itraconazole
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Budesonide
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Cytochrome P-450 Enzyme System
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Clarithromycin