title: Adrenal Insufficiency With Voriconazole and Inhaled/Intranasal Corticosteroids: Case Report and Systematic Review.
abstract: Strong cytochrome P450 (CYP) 3A4 inhibitors may induce Cushing syndrome and subsequent adrenal insufficiency when administered concurrently with corticosteroids. This drug-drug interaction has been well described with HIV protease inhibitors. A similar drug-drug interaction with corticosteroids and other strong CYP 3A4 inhibitors (antifungals [imidazoles]) has recently been reported but remains less well known. To our knowledge, we report the first case of probable drug-induced Cushing syndrome with subsequent adrenal insufficiency as a result of concomitant oral voriconazole with intranasal mometasone and inhaled fluticasone administration as well as a review of the current literature supporting this drug-drug interaction.
authors.affiliation: 1 Department of Pharmacy, Medical College of Virginia Hospitals, Virginia Commonwealth University Health System, Richmond, VA, USA.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Duman
authors.affiliation: 2 Department of Pharmacy, Division of Infectious Diseases, Medical College of Virginia Hospitals, Virginia Commonwealth University Health System, Richmond, VA, USA.
authors.forename: Patricia Pecora
authors.initials: PP
authors.lastname: Fulco
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D003480:Cushing Syndrome / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood; D004347:Drug Interactions / Q000502:physiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D065819:Voriconazole / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D065819:Voriconazole
keywords: Cushing syndrome; adrenal insufficiency; fluticasone; mometasone; voriconazole