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1 results

  • Complications of combination intranasal corticosteroids and anti-retroviral therapy

  • J James, L Caulley, J Collins, C Hopkins
  • Journal:
    The Journal of Laryngology & Otology / Volume 135 / Issue 12 / December 2021
    Published online by Cambridge University Press:
    28 September 2021, pp. 1119-1122
    Print publication:
    December 2021
  • 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.