Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T20:09:32.242Z Has data issue: false hasContentIssue false
  • English
  • Français

Complications of combination intranasal corticosteroids and anti-retroviral therapy

Published online by Cambridge University Press:  28 September 2021

J James ,
L Caulley ,
J Collins  and
C Hopkins
J James
Affiliation:
City University of New York School of Medicine, USA
L Caulley
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Ottawa, Ottawa Hospital, Canada Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Canada Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
J Collins
Affiliation:
ENT Department, Guy's Hospital, London, UK
C Hopkins*
Affiliation:
ENT Department, Guy's Hospital, London, UK
*
Author for correspondence: Professor Claire Hopkins, ENT Department, Guy's Hospital, Great Maze Pond, LondonSE1 9RT, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Intranasal corticosteroids are widely used for management of many upper airway diseases because of their ability to effectively deliver local relief of inflammation.

Case report

This paper presents the case of a 51-year-old man with human immunodeficiency virus treated with ritonavir who was started on fluticasone intranasal spray for presumed chronic rhinosinusitis. Months after starting this therapy, he developed symptoms of Cushing's syndrome and avascular necrosis of the shoulder due to the pharmacological interactions between fluticasone and ritonavir.

Conclusion

Although intranasal corticosteroids are deemed a low-risk route of drug administration, clinicians need to be vigilant in appropriately prescribing corticosteroids in the setting of drug potentiators, particularly in these high-risk patients. Alternative corticosteroids such as beclomethasone dipropionate should be considered in such cases.

Keywords

FluticasoneCushing SyndromeOsteonecrosisSinusitisHIVDrug InteractionsRitonavir
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 12 , December 2021 , pp. 1119 - 1122
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Prof C Hopkins takes responsibility for the integrity of the content of the paper

References

de Benedictis, FM, Bush, A. Corticosteroids in respiratory diseases in children. Am J Respir Crit Care Med 2012;185:12–23CrossRefGoogle ScholarPubMed
Chong, LY, Head, K, Hopkins, C, Philpott, C, Schilder, AG, Burton, MJ. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane Database Syst Rev 2016;(4):CD011996Google ScholarPubMed
Trangsrud, AJ, Whitaker, AL, Small, RE. Intranasal corticosteroids for allergic rhinitis. Pharmacotherapy 2002;22:1458–67CrossRefGoogle ScholarPubMed
Arnaldi, G, Angeli, A, Atkinson, AB, Bertagna, X, Cavagnini, F, Chrousos, GP et al. Diagnosis and complications of Cushing's syndrome: a consensus statement. J Clin Endocrinol Metab 2003;88:5593–602CrossRefGoogle ScholarPubMed
Saberi, P, Phengrasamy, T, Nguyen, DP. Inhaled corticosteroid use in HIV-positive individuals taking protease inhibitors: a review of pharmacokinetics, case reports and clinical management. HIV Med 2013;14:519–29CrossRefGoogle ScholarPubMed
Pollett, S, Graves, B, Richards, B, MacLeod, C. Avascular necrosis in a HIV patient receiving ritonavir and inhaled fluticasone. Int J STD AIDS 2014;25:458–60CrossRefGoogle Scholar
Epperla, N, McKiernan, F. Iatrogenic Cushing syndrome and adrenal insufficiency during concomitant therapy with ritonavir and fluticasone. Springerplus 2015;4:455CrossRefGoogle ScholarPubMed
Canalejo, E, Pacheco, MS. Cushing syndrome due to ritonavir-fluticasone interaction. CMAJ 2012;184:171410.1503/cmaj.111315CrossRefGoogle ScholarPubMed
Azevedo, L, Pego, H, Souto Moura, T, Germano, I. Iatrogenic Cushing's syndrome and osteoporosis due to an interaction between fluticasone and ritonavir. BMJ Case Rep 2015;2015:bcr201521108010.1136/bcr-2015-211080CrossRefGoogle Scholar
Wood, BR, Lacy, JM, Johnston, C, Weigle, DS, Dhanireddy, S. Adrenal insufficiency as a result of ritonavir and exogenous steroid exposure: report of 6 cases and recommendation for management. J Int Assoc Provid AIDS Care 2015;14:300–5CrossRefGoogle ScholarPubMed
Gray, D, Roux, P, Carrihill, M, Klein, M. Adrenal suppression and Cushing's syndrome secondary to ritonavir and budesonide. S Afr Med J 2010;100:296–710.7196/SAMJ.3848CrossRefGoogle ScholarPubMed
Figueiredo, J, Serrado, M, Khmelinskii, N, do Vale, S. Iatrogenic Cushing syndrome and multifocal osteonecrosis caused by the interaction between inhaled fluticasone and ritonavir. BMJ Case Rep 2020;13:e233712CrossRefGoogle ScholarPubMed
Soparkar, CN, Patrinely, JR, Cuaycong, MJ, Dailey, RA, Kersten, RC, Rubin, PA et al. The silent sinus syndrome. A cause of spontaneous enophthalmos. Ophthalmology 1994;101:772–8Google ScholarPubMed
Mygind, N, Nielsen, LP, Hoffmann, HJ, Shukla, A, Blumberga, G, Dahl, R et al. Mode of action of intranasal corticosteroids. J Allergy Clin Immunol 2001;108(1 suppl):S16–2510.1067/mai.2001.115561CrossRefGoogle ScholarPubMed
Sastre, J, Mosges, R. Local and systemic safety of intranasal corticosteroids. J Investig Allergol Clin Immunol 2012;22:1–12Google ScholarPubMed
Derendorf, H, Hochhaus, G, Meibohm, B, Mollmann, H, Barth, J. Pharmacokinetics and pharmacodynamics of inhaled corticosteroids. J Allergy Clin Immunol 1998;101:S440–610.1016/S0091-6749(98)70156-3CrossRefGoogle ScholarPubMed
Stanbury, RM, Graham, EM. Systemic corticosteroid therapy--side effects and their management. Br J Ophthalmol 1998;82:704–8CrossRefGoogle ScholarPubMed
Weinstein, RS. Glucocorticoid-induced osteonecrosis. Endocrine 2012;41:183–90CrossRefGoogle ScholarPubMed
Felson, DT, Anderson, JJ. Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone. Lancet 1987;1:902–610.1016/S0140-6736(87)92870-4CrossRefGoogle ScholarPubMed
Drescher, W, Schlieper, G, Floege, J, Eitner, F. Steroid-related osteonecrosis--an update. Nephrol Dial Transplant 2011;26:2728–3110.1093/ndt/gfr212CrossRefGoogle ScholarPubMed
Massardo, L, Jacobelli, S, Leissner, M, Gonzalez, M, Villarroel, L, Rivero, S. High-dose intravenous methylprednisolone therapy associated with osteonecrosis in patients with systemic lupus erythematosus. Lupus 1992;1:401–5CrossRefGoogle ScholarPubMed
Chan, KL, Mok, CC. Glucocorticoid-induced avascular bone necrosis: diagnosis and management. Open Orthop J 2012;6:449–5710.2174/1874325001206010449CrossRefGoogle ScholarPubMed
Yamamoto, T, Schneider, R, Iwamoto, Y, Bullough, PG. Rapid destruction of the femoral head after a single intraarticular injection of corticosteroid into the hip joint. J Rheumatol 2006;33:1701–4Google ScholarPubMed
Jia, D, O'Brien, CA, Stewart, SA, Manolagas, SC, Weinstein, RS. Glucocorticoids act directly on osteoclasts to increase their life span and reduce bone density. Endocrinology 2006;147:5592–9CrossRefGoogle ScholarPubMed
O'Brien, CA, Jia, D, Plotkin, LI, Bellido, T, Powers, CC, Stewart, SA et al. Glucocorticoids act directly on osteoblasts and osteocytes to induce their apoptosis and reduce bone formation and strength. Endocrinology 2004;145:1835–41CrossRefGoogle ScholarPubMed
Weinstein, RS, Chen, JR, Powers, CC, Stewart, SA, Landes, RD, Bellido, T et al. Promotion of osteoclast survival and antagonism of bisphosphonate-induced osteoclast apoptosis by glucocorticoids. J Clin Invest 2002;109:1041–8CrossRefGoogle ScholarPubMed
Weinstein, RS, Jilka, RL, Parfitt, AM, Manolagas, SC. Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Invest 1998;102:274–82CrossRefGoogle ScholarPubMed
Weinstein, RS, Wan, C, Liu, Q, Wang, Y, Almeida, M, O'Brien, CA et al. Endogenous glucocorticoids decrease skeletal angiogenesis, vascularity, hydration, and strength in aged mice. Aging Cell 2010;9:147–61CrossRefGoogle ScholarPubMed
Mankin, HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 1992;326:1473–9Google Scholar
Hsu, A, Granneman, GR, Bertz, RJ. Ritonavir. Clinical pharmacokinetics and interactions with other anti-HIV agents. Clin Pharmacokinet 1998;35:275–91Google ScholarPubMed
Bayard, C, Ledergerber, B, Flepp, M, Lecompte, T, Moulin, E, Hoffmann, M et al. Associations between antiretroviral treatment and avascular bone necrosis: The Swiss HIV Cohort Study. Open Forum Infect Dis 2017;4:ofx17710.1093/ofid/ofx177CrossRefGoogle ScholarPubMed
Hillebrand-Haverkort, ME, Prummel, MF, ten Veen, JH. Ritonavir-induced Cushing's syndrome in a patient treated with nasal fluticasone. AIDS 1999;13:1803CrossRefGoogle Scholar
Chen, F, Kearney, T, Robinson, S, Daley-Yates, PT, Waldron, S, Churchill, DR. Cushing's syndrome and severe adrenal suppression in patients treated with ritonavir and inhaled nasal fluticasone. Sex Transm Infect 1999;75:274Google ScholarPubMed
Daley-Yates, PT, Baker, RC. Systemic bioavailability of fluticasone propionate administered as nasal drops and aqueous nasal spray formulations. Br J Clin Pharmacol 2001;51:103–5CrossRefGoogle ScholarPubMed
Scadding, GK. Optimal management of allergic rhinitis. Arch Dis Child 2015;100:576–8210.1136/archdischild-2014-306300CrossRefGoogle ScholarPubMed
Daley-Yates, PT, Price, AC, Sisson, JR, Pereira, A, Dallow, N. Beclomethasone dipropionate: absolute bioavailability, pharmacokinetics and metabolism following intravenous, oral, intranasal and inhaled administration in man. Br J Clin Pharmacol 2001;51:400–9CrossRefGoogle ScholarPubMed
Boyd, SD, Hadigan, C, McManus, M, Chairez, C, Nieman, LK, Pau, AK et al. Influence of low-dose ritonavir with and without darunavir on the pharmacokinetics and pharmacodynamics of inhaled beclomethasone. J Acquir Immune Defic Syndr 2013;63:355–61CrossRefGoogle ScholarPubMed