title: Triamcinolone acetonide induced secondary adrenal insufficiency related to impaired CYP3A4 metabolism by coadministration of nefazodone.
abstract: OBJECTIVE
  This case report seeks to promote physician awareness of the potential drug interaction between corticosteroid medications and cytochrome P450 3A4 (CYP3A4) inhibitors.
  
  
  METHODS
  Tertiary care multispecialty referral center.
  
  
  CONCLUSIONS
  Corticosteroid injections are commonly used as effective treatments for a variety of pain disorders. Recently, there has been a greater appreciation of the potential drug interactions between CYP3A4 inhibitors and corticosteroid medications including topical steroid preparations. We report a case of triamcinolone acetonide induced secondary adrenal insufficiency related to impaired CYP3A4 metabolism by coadministration of nefazodone.
  
  
  CONCLUSIONS
  Physicians should recognize the potential effects of CYP3A4 inhibitors particularly when administering or prescribing systemic corticosteroid medications.
authors.affiliation: Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. hagan.john@mayo.edu
authors.forename: John B
authors.initials: JB
authors.lastname: Hagan
authors.forename: Dana
authors.initials: D
authors.lastname: Erickson
authors.forename: Ravinder J
authors.initials: RJ
authors.lastname: Singh
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000328:Adult; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D065692:Cytochrome P-450 CYP3A Inhibitors; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010879:Piperazines; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D000893:Anti-Inflammatory Agents; D018687:Antidepressive Agents, Second-Generation; D065692:Cytochrome P-450 CYP3A Inhibitors; D004791:Enzyme Inhibitors; D010879:Piperazines; D014230:Triazoles; C051752:nefazodone; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D014222:Triamcinolone Acetonide