Adrenal Insufficiency With Voriconazole and Inhaled/Intranasal Corticosteroids: Case Report and Systematic Review. (August 2017)

• Record Type: Journal Article
• Authors: Duman, Amanda K.; Fulco, Patricia Pecora
• Other Names: Millares-Sipin Catherine A. guest-editor.
• Is Part Of: Journal of pharmacy practice. Volume 30:Number 4(2017:Aug.)
• Page Start: 459
• Page End: 463
• Publication Date: 2017-08
• Subjects: mometasone -- fluticasone -- adrenal insufficiency -- Cushing syndrome -- voriconazole; Pharmacy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1177/0897190016646510
• Languages: English
• ISSNs: 0897-1900

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.