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

HIV Med. 2013 Oct;14(9):519-29. doi: 10.1111/hiv.12039. Epub 2013 Apr 16.

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: HIV; corticosteroid; drug interactions; pharmacokinetics; protease inhibitors; ritonavir.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Administration, Inhalation
  • Administration, Intranasal
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / pharmacokinetics*
  • Adult
  • Aged
  • Anti-Inflammatory Agents / pharmacokinetics
  • Beclomethasone / administration & dosage
  • Beclomethasone / adverse effects
  • Beclomethasone / pharmacokinetics
  • Child
  • Child, Preschool
  • Cushing Syndrome / chemically induced
  • Cushing Syndrome / drug therapy
  • Drug Interactions
  • Female
  • Fluocinolone Acetonide / administration & dosage
  • Fluocinolone Acetonide / adverse effects
  • Fluocinolone Acetonide / analogs & derivatives
  • Fluocinolone Acetonide / pharmacokinetics
  • HIV Protease Inhibitors / administration & dosage
  • HIV Protease Inhibitors / adverse effects
  • HIV Protease Inhibitors / therapeutic use*
  • HIV Seropositivity / drug therapy*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Ritonavir / administration & dosage
  • Ritonavir / adverse effects
  • Ritonavir / pharmacokinetics
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • HIV Protease Inhibitors
  • Fluocinolone Acetonide
  • Beclomethasone
  • Ritonavir
  • flunisolide