Lopinavir Fluticasone

Cushing s syndrome occurred in a 44-year-old HIVpositive patient who used inhaled fluticasone (500 micrograms qds) for severe asthma for 2 years (153). Stavudine and nevirapine were replaced by abacavir and ritonavir + lopinavir and 2 months later he developed the typical features of Cushing syndrome. 

In this case an interaction of ritonavir + lopinavir with fluticasone was suspected, because fluticasone is metabolized by CYP3A4, which ritonavir inhibits. 

Rouanet I, Peyriere H, Mauboussin JM, Vincent D. Cushing s syndrome in a patient treated by ritonavir/lopinavir and inhaled fluticasone. HIV Med 2003 4 149-50. 

CORTICOSTEROIDS PROTEASE INHIBITORS-RITONAVIR t plasma levels of betamethasone, dexamethasone, hydrocortisone, prednisolone and both inhaled and intranasal budesonide and fluticasone with ritonavir (with or without lopinavir) Inhibition of CYP3A4-mediated metabolism Monitor closely for signs of corticosteroid toxicity and immunosupression, and i dose as necessaiy. Consider using inhaled bedometasone... 

There are reports of at least 9 other patients, including 2 children, who have developed Cushing s syndrome within 2 to 5 months of using regimens of inhaled " or intranasal fluticasone, with ritonavir, ritonavir/ amprenavir, ritonavir/lopinavir, ritonavir/saquinavir, ... 

---