Inhaled budesonide induced Cushing's syndrome in cystic fibrosis patients, due to drug inhibition of cytochrome P450.
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.
Department of Paediatrics, Paediatric Respiratory Medicine and Cystic Fibrosis Clinic, Academisch Ziekenhuis-Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
Elke
E
De Wachter
Anne
A
Malfroot
Iris
I
De Schutter
Jesse
J
Vanbesien
Jean
J
De Schepper
D000280:Administration, Inhalation; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D000935:Antifungal Agents / Q000009:adverse effects; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000188:drug therapy; D001232:Aspergillus fumigatus; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D017291:Clarithromycin / Q000009:adverse effects; D003480:Cushing Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D003550:Cystic Fibrosis / Q000150:complications* / Q000378:metabolism; D065607:Cytochrome P-450 Enzyme Inhibitors; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004927:Escherichia coli Infections / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007231:Infant, Newborn; D017964:Itraconazole / Q000009:adverse effects; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D001993:Bronchodilator Agents; D065607:Cytochrome P-450 Enzyme Inhibitors; D017964:Itraconazole; D019819:Budesonide; D003577:Cytochrome P-450 Enzyme System; D017291:Clarithromycin