Iatrogenic Cushing syndrome and adrenal insufficiency during concomitant therapy with ritonavir and fluticasone

SpringerPlus
Narendranath Epperla, Fergus McKiernan

Abstract

Ritonavir is a potent inhibitor of the cytochrome P450 enzyme CYP3A4 and is subject to multiple drug-drug interactions. This becomes especially important when the patient is also taking medications metabolized through CYP3A pathway as increased and potentially toxic drug levels may ensue. Herein we present one such interaction wherein a 57 year old gentleman with human immunodeficiency virus (HIV) infection on highly active antiretroviral therapy that included ritonavir, had addition of fluticasone inhaler to his medication repertoire for treatment of chronic obstructive pulmonary disease. This resulted in severe osteoporosis, iatrogenic Cushing syndrome and adrenal insufficiency due to the potentiated systemic glucocorticoid effect of inhaled fluticasone by ritonavir. This case emphasizes the need for pharmacovigilance when managing patients on complex drug regimens for physicians treating HIV infected patients.

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Citations

Jan 28, 2017·Expert Review of Respiratory Medicine·Choua ThaoChristian Woods
Nov 10, 2017·Endocrinology, Diabetes & Metabolism Case Reports·Gueorgui DubrocqNatella Rakhmanina
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Feb 6, 2021·Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia·Emin Murat Akbas, Nergis Akbas
May 11, 2020·Diabetes & Metabolic Syndrome·Rimesh Pal, Sanjay K Bhadada
Sep 29, 2021·The Journal of Laryngology and Otology·J JamesC Hopkins

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Methods Mentioned

BETA
electrophoresis
X-ray

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