Itraconazole Fluticasone

Clinically important, potentially hazardous interactions with abacavir, atorvastatin, bepridil, bupropion, carbamazepine, clarithromycin, cyclosporine, dexamethasone, digoxin, felodipine, fluticasone propionate, fosamprenavir, itraconazole, ketoconazole, lovastatin, methadone, midazolam, nicardipine, nifedipine, phenobarbital, phenytoin, rifabutin, simvastatin, sirolimus, St John s wort, systemic lidocaine, tacrolimus, tenofovir, trazodone, vinblastine, vincristine, voriconazole, warfarin, zidovudine... 

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... 

A case report describes profound adrenal suppression with secondary Cushing s syndrome in a patient with cystic fibrosis given itraconazole 200 mg twice daily and low-dose inhaled fluticasone 250 micrograms daily. Another report describes a patient with asthma who had been taking inhaled fluticasone 1 to 1.5 mg twice daily for 2 years who developed secondary Cushing s syndrome and adrenal suppression 6 weeks after starting itraeonazole (initially 100 mg daily then 200 mg daily). ... 

The incidence of h3q)othalamic-pituitary-adrenal axis suppression caused by concomitant administration of itraconazole and inhaled fluticasone was assessed by synacthen tests in 12 patients with cystic fibrosis receiving both medica-hons versus 12 patients on fluticasone alone [2 ]. The concomitant use of the above medications caused moderate to severe axis suppression in 5/12 patients. In contrast, fluticasone alone, only caused mild suppression in 2/12 controls. Neither itraconazole levels nor fluticasone dose appeared to be correlated with the degree of adrenal suppression. 

Gilchrist FJ, Cox KJ, Rowe R, Horsley A, Webb AK, Jones AM, et al. Itraconazole and inhaled fluticasone causing hypothalamic-pituitary-adrenal axis suppression in adults with cystic fibrosis. J Cyst Fibros July 2013 12(4) 399-402. 

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