Ketoconazole effects on methylprednisolone disposition and their joint suppression of endogenous cortisol.
The effects of ketoconazole and methylprednisolone on endogenous cortisol were studied in eight normal subjects. Intravenous methylprednisolone sodium succinate was given alone in doses of 15 or 30 mg. The methylprednisolone dose was reduced by 57% when ketoconazole was administered chronically for 1 week to seek equivalent methylprednisolone AUCs by compensating for the expected reduction in methylprednisolone clearance. Ketoconazole decreased clearance by 46% and increased mean residence time by 37%. The ratio of the cortisol AUC during each drug treatment compared with baseline conditions was used to assess the net extent and duration of cortisol suppression. This cortisol AUC ratio was reduced from 0.45 (methylprednisolone) to 0.39 (methylprednisolone plus ketoconazole), suggesting that ketoconazole modestly enhanced (P less than 0.01) cortisol suppression. Based on the reduction in methylprednisolone clearance and cortisol AUC by ketoconazole, a 50% lower dose of methylprednisolone during concomitant therapy with ketoconazole is recommended.
Kandrotas
R J
RJ
Department of Pharmacy, School of Pharmacy, State University of New York, Buffalo 14260.
Slaughter
R L
RL
Brass
C
C
Jusko
W J
WJ
D000328:Adult; D000704:Analysis of Variance; D002986:Clinical Trials as Topic; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007654:Ketoconazole / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008775:Methylprednisolone / Q000031:analogs & derivatives*; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D011897:Random Allocation; D013997:Time Factors
D008776:Methylprednisolone Hemisuccinate; D007654:Ketoconazole; D006854:Hydrocortisone; D008775:Methylprednisolone