title: Inhaled corticosteroid use in HIV-positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management.
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.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Saberi
authors.forename: T
authors.initials: T
authors.lastname: Phengrasamy
authors.forename: D P
authors.initials: DP
authors.lastname: Nguyen
mesh_terms: D000280:Administration, Inhalation; D000281:Administration, Intranasal; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000493:pharmacokinetics; D001507:Beclomethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002648:Child; D002675:Child, Preschool; D003480:Cushing Syndrome / Q000139:chemically induced / Q000188:drug therapy; D004347:Drug Interactions; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006679:HIV Seropositivity / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D017320:HIV Protease Inhibitors; D005446:Fluocinolone Acetonide; C007734:flunisolide; D001507:Beclomethasone; D019438:Ritonavir
keywords: HIV; corticosteroid; drug interactions; pharmacokinetics; protease inhibitors; ritonavir