Itraconazole Budesonide

Budesonide, Oral (Entocort EC) [Anti-inflammatory> Corticosteroid] Uses Mild-mod Crohn Dz Action Steroid, anti-inflammatory Dose Adults. Initial, 9 mg PO qAM to 8 wk max maint 6 mg PO qAM taper by 3 mo avoid grapefruit juice Contra Active TB and fungal Infxn Caution [C, /-] DM, glaucoma, cataracts, HTN, CHF Disp Caps SE HA, cough, hoarseness, Candida Infxn, epistaxis Interactions T Effects W/ erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, grapefruit EMS Monitor ECG and BP for signs of electrolyte disturbances and hypovolemia OD Acute OD unlikely to cause a problem, chronic OD can reduce natural production of certain steroids symptomatic and supportive... 

Interactions with other drugs can increase plasma concentrations of inhaled glucocorticoids. Itraconazole, a potent inhibitor of CYP3A4, markedly increased plasma concentrations of inhaled budesonide (154). 

Cushing s syndrome of rapid onset occurred during combined treatment with inhaled budesonide and itraconazole (155). 

This adverse effect could have been due to inhibition of the metabolism of budesonide by itraconazole. 

Cushing s syndrome has been attributed to the combination of itraconazole and inhaled budesonide (156). 

Raaska K, Niemi M, Neuvonen M, Neuvonen PJ, Kivisto KT. Plasma concentrations of inhaled budesonide and its effects on plasma cortisol are increased by the cytochrome P4503A4 inhibitor itraconazole. Clin Pharmacol Ther 2002 72(4) 362-9. 

De Wachter E, Vanbesien J, De Schutter I, Malfroot A, De Schepper J. Rapidly developing Cushing syndrome in a 4-year-old patient during combined treatment with itraconazole and inhaled budesonide. Eur J Pediatr 2003 162 488-9. 

The effects of itraconazole on the pharmacokinetics and cortisol-suppressing activity of budesonide by inhalation were further investigated in a randomized, doubleblind, two-phase, crossover study in 10 healthy subjects who took oral itraconazole 200 mg/day or placebo for 5 days (93). On day 5, 1 hour after the last dose of... 

Skov M, Main KM, Sillesen IB, Muller J, Koch C, Lanng S. Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide. Eur Respir J 2002 20(l) 127-33. 

There is some evidence to surest that itraconazole can increase the ieveis and/or effects of inhaled budesonide, the active metab-oiite of ciclesonide, deflazacort, dexamethasone and methylpred-nisoione, and, to a lesser extent, prednisolone and prednisone. A few case reports describe the development of secondary Cnsh-ing s syndrome in patients taking itraconazole and bndesonide, fluticasone and deflazacort... 

Two other reports describe the development of Cushing s syndrome in patients with cystic fibrosis given inhaled budesonide, and then itraconazole for bronchopulmonary aspergillosis. One patient was also taking clarithromycin, which may have contributed to the increased budesonide effects (see also Corticosteroids+Macrolides , p. 1056). The other patient was a 4-year-old boy who developed Cushing s syndrome 2 weeks after starting treatment with itraconazole 200 mg daily and inhaled budesonide 400 micrograms daily. ... 

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