Rapid Onset of Iatrogenic Adrenal Insufficiency in a Patient with Cystic Fibrosis–Related Liver Disease Treated with Inhaled Corticosteroids and a Moderate CYP3A4 Inhibitor

Hoover, Wynton; Britton, LaCrecia J; Gardner, Jay; Jackson, Tracy L; Gutierrez, Hector

doi:10.1345/aph.1q103

Cited by 21 publications

(18 citation statements)

References 8 publications

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“…One notable example of such an interaction is that of azole antifungals and corticosteroids. Several case reports note adverse effects, including hypothalamic‐pituitary axis suppression, adrenal insufficiency, and growth failure, when inhaled corticosteroids were used chronically with itraconazole or fluconazole . These reports point out the potential interaction between medications that are quite commonly utilized together (Table ).…”

Section: Drug Metabolism Pathways: General Considerationsmentioning

confidence: 99%

Therapeutic challenges posed by critical drug–drug interactions in cystic fibrosis

Jordan

Noah

Henry

2016

Pediatric Pulmonology

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This review seeks to re-introduce cystic fibrosis (CF) clinicians to the pharmacology of drug-drug interactions among medications commonly used in CF and provide a framework for understanding these interactions among medications outside the scope of this discussion. We here focus on drugs impacted by the cytochrome P-450 (CYP450) enzyme system and on interactions involving antimicrobials, psychotropic medications, and cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Particular attention is needed when prescribing rifampin, azole antifungals and the CFTR modulators, ivacaftor, and lumacaftor/ivacaftor, in combination with other medications. The complexities of these interactions provide a strong rationale for case management by pharmacists and pharmacologists as a routine part of CF care. Pediatr Pulmonol. 2016;51:S61-S70. © 2016 Wiley Periodicals, Inc.

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Section: Drug Metabolism Pathways: General Considerationsmentioning

confidence: 99%

Therapeutic challenges posed by critical drug–drug interactions in cystic fibrosis

Jordan

Noah

Henry

2016

Pediatric Pulmonology

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“…Seven weeks after the initiation of inhaled fluticasone, she developed vaginal candidiasis and was prescribed fluconazole 100 mg/day. Iatrogenic Cushing syndrome was shown in this patient with inhaled FP and a CYP3A4 inhibitor, fluconazole [15]. Table 2 shows that several drugs inhibit cytochrome P450 dependent CYP3A4 and CYP2D6 and consequently decrease the clearance of synthetic glucocorticoids.…”

Section: Discussionmentioning

confidence: 95%

Iatrogenic Cushing’s syndrome with inhaled steroid plus antidepressant drugs

Çelik

Niyazoğlu

Soylu

et al. 2012

Multidisciplinary Respiratory Medicine

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Current guidelines recommend the use of inhaled corticosteroids (ICS) for suppression of airway inflammation in patients with asthma. Although it is well known that ICS cause dose-related adrenocortical suppression, it is less known that they can lead to iatrogenic Cushing’s syndrome (CS). Fluticasone propionate (FP) is an ICS more potent than beclomethasone and budesonide. FP is metabolized as mediated by cytochrome P450 3A4 in the liver and the gut. Systemic bioactivity of FP can increase with the use of drugs that affect the cytochrome P450. Herein, we report the rapid development of iatrogenic CS in a patient receiving paroxetine and mirtazepine for 12 weeks in addition to inhaled FP.

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“…immunosuppressant and anti-retroviral therapies [8e10]. Itraconazole is a commonly used drug in CF, which is widely available and relatively inexpensive, and has previously been reported to cause significant non-beneficial drugedrug interactions due to CYP3A inhibition [11]. Given that these co-habiting siblings had shared dietary and other environmental exposures, concomitant use of Itraconazole with Ivacaftor in one sibling appears to explain the similar outcomes during 36 weeks of Ivacaftor therapy despite that sibling using only 1/7th the standard dose.…”

Section: Discussionmentioning

confidence: 99%

Ivacaftor therapy in siblings with cystic fibrosis-the potential implications of Itraconazole in dosage and efficacy

Harrison¹,

Ronan²,

Khan³

et al. 2015

Pulmonary Pharmacology & Therapeutics

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Rapid Onset of Iatrogenic Adrenal Insufficiency in a Patient with Cystic Fibrosis–Related Liver Disease Treated with Inhaled Corticosteroids and a Moderate CYP3A4 Inhibitor

Abstract: CYP3A4-mediated drug interactions represent a significant risk in patients treated with long-term inhaled corticosteroids. The presence of clinically significant CF-related liver disease may enhance this risk.

Cited by 21 publications

References 8 publications

Therapeutic challenges posed by critical drug–drug interactions in cystic fibrosis

Therapeutic challenges posed by critical drug–drug interactions in cystic fibrosis

Iatrogenic Cushing’s syndrome with inhaled steroid plus antidepressant drugs

Ivacaftor therapy in siblings with cystic fibrosis-the potential implications of Itraconazole in dosage and efficacy

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