Itraconazole Corticosteroids

Fluconazole 12 mg/kg/day PO for 6-12 weeks transitioned to itraconazole or fluconazole Corticosteroid therapy should be considered in hypoxic patients with acute pulmonary infection... 

Drugs that may affect repaglinide include CYP 450 inhibitors (eg, clarithromycin, erythromycin, ketoconazole, miconazole), CYP 450 inducers (eg, barbiturates, carbamazepine, rifampin), beta blockers, calcium channel blockers, chloramphenicol, corticosteroids, coumarins, estrogens, gemfibrozil, isoniazid, itraconazole, levonorgestrel and ethinyl estradiol, MAOIs, nicotinic acid, NSAIDs, oral contraceptives, phenothiazines, phenytoin, probenecid, salicylates, simvastatin, sulfonamides, sympathomimetics, thiazides and other diuretics, and thyroid products. 

Drugs that may be affected by itraconazole include alfentanil, almotriptan, alprazolam, amphotericin B, aripiprazole, benzodiazepines, buspirone, busulfan, calcium blockers, carbamazepine, cilostazol, cisapride, corticosteroids, cyclosporine, digoxin, disopyramide, docetaxel, dofetilide, eletriptan, epierenone, ergot alkaloids, haloperidol, HMG-CoA reductase inhibitors, hydantoins (phenytoin), hypoglycemic agents, oral midazolam, phosphodiesterase type 5 inhibitors, pimozide, polyenes, protease inhibitors, quinidine, rifamycins, sirolimus, tacrolimus, tolterodine, triazolam, trimetrexate, vinca alkaloids, warfarin, and zolpidem. 

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... 

Bolland MJ, Bagg W, Thomas MG, Lucas JA, Ticehurst R, Black PN. Cushing s syndrome due to interaction between inhaled corticosteroids and itraconazole. Ann Pharmacother 2004 38 46-9. 

Self-limited disease Amphotericin 6 0.3-0.5 mg/kg/day x 2-4 weeks (total dose 500 or ketoconazole 400 mg orally daily x 3-6 months can be beneficial in patients with severe hypoxia following inhalation of large inocula Antifungal therapy generally not useful for arthritis or pericarditis NSAIDs or corticosteroids can be useful in some cases Most lesions resolve spontaneously surgery or antifungal therapy with amphotericin B 40-50 mg/dayx2-3 weeks or itraconazole 400 m day orally x 6-12 months can be beneficial in some severe cases mild to moderate disease can be treated wHh itraconazole for 6-12 months Amphotericin B 0.7 mg/k day, for a total dose of SSm kg (or 3 rng/k day of one of the lipid preparations) prednisone 60 mg daily tapered over 2 weeks/ followed by itraconazole 200 rng twice daily for 6-12 weeks in patients who do not require hospitalization, itraconazole 200 mg once or twice daily for 6-12 weeks can be used... 

CORTICOSTEROIDS AZOLES - FLUCONAZOLE, ITRACONAZOLE, KETOCONAZOLE, POSACONAZOLE, VORICONAZOLE t adrenal suppressive effects of corticosteroids, which may t risk of infections and produce inadequate response to stress scenarios Due to inhibition of metabolism of corticosteroids Monitor cortisol levels and warn patients to report symptoms such as fever and sore throat... 

Caspofungin, itraconazole, ketoconazole, posaconazole Systemic corticosteroids, caspofungin, itraconazole, voriconazole, ketoconazole, fluconazole, erythromycins... 

Clinically important, potentially hazardous interactions with acetaminophen, ciprofloxacin, corticosteroids, dapsone, itraconazole, ketoconazole, lomefloxacin, sulfones, tenofovir, tetracycline... 

Clinically important, potentially hazardous interactions with amlodipine, anisindione, anticoagulants, aprepitant, atorvastatin, barbiturates, benzodiazepines, butabarbital, carbamazepine, chlordiazepoxide, clarithromycin, clonazepam, dorazepate, corticosteroids, cyclosporine, dexamethasone, diazepam, dicumarol, erythromycin, ethotoin, felodipine, flurazepam, fluvastatin, fosphenytoin, isradipine, itraconazole, ketoconazole, lorazepam, lovastatin, mephenytoin, mephobarbital, midazolam, nicardipine, nifedipine, nimodipine, nisoldipine, oxazepam, pentobarbital, phenobarbital, pimozide, pravastatin, primidone, quazepam, rifampin, secobarbital, simvastatin, St John s wort, temazepam, warfarin... 

Clinically important, potentially hazardous interactions with amiodarone, amprenavir, anisindione, antacids, anticoagulants, aprepitant, atazanavir, atovaquone, beclomethasone, buprenorphine, corticosteroids, cortisone, cyclosporine, cyproterone, dabigatran, dapsone, darunavir, delavirdine, dexamethasone, dicumarol, digoxin, eszopiclone, flunisolide, fosamprenavir, gadoxetate, gestrinone, halothane, imatinib, isoniazid, itraconazole, ketoconazole, lapatinib, lorcainide, methylprednisolone, midazolam, nelfinavir, nifedipine, oral contraceptives, phenylbutazone, prednisone, protease inhibitors, pyrazinamide, ramelteon, ritonavir, saquinavir, solifenacin, sunitinib, tacrolimus, telithromycin, temsirolimus, tipranavir, tolvaptan, trabectedin, triamcinolone, triazolam, voriconazole, warfarin, zaleplon... 

Inflammatory/fibrotic disease 0.02 Fibrosing mediastinitis Jhe benefit of antifungal therapy (itraconazole 200 mg twice daily x 3 months) is controversial but should be considered, especially in patients with elevated ESR or CFS titers >1 32 surgery may be of benefit if disease is detected early late disease may not respond to therapy Sarcoid-like NSAIDs or corticosteroids may be of benefit for some patients Pericarditis Severe disease corticosteroids 1 mg/kg/day or pericardial drainage procedure... 

Ketoconazole has been replaced by itraconazole for the treatment of aU mycoses except when cost is the primary determinant. Itraconazole lacks ketoconazole s corticosteroid suppression, while retaining most of its properties and expanding the antifungal spectrum. 

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. ... 

Voriconazole is an inhihitor of the cytochrome P450 isoenzyme CYP3A4, hirt its inhihitory effects are much less than those of itraconazole. Therefore voriconazole is less likely than itraconazole , (p.l050), or ketoconazole , (p.l051) to affect the pharmacokinetics of the corticosteroids. 

The serum levels of the active metabolite of leflunomide are reduced by activated charcoal, and colestyramine. The manufacturers advise against the concurrent use of alcohol because of the potential for hepatotoxicity. Methotrexate may also increase leflunomide hepatotoxicity, so in general the combination is not recommended. A case of fatal fulminant hepatic failure has been reported in a patient taking leflunomide and itraconazole. A case of peripheral neuropathy has been reported in a patient taking leflunomide and tegafiir/uraciL The manufacturers predict interactions between leflunomide and phenytoin or tolbutamide, and advise caution with rifampicin as it may increase leflunomide metabolite levels. No clinically relevant interaction occurs with cime-tidine, corticosteroids or NSAIDs. 

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