OBJECT DRUGS

Corticosteroids:

• Budesonide (Entocort, etc.)
• Cortisone (Cortone)
• Mometasone (Asmanex, etc.)
• Dexamethasone (Decadron, etc.)
• Fluticasone (Flovent, etc.)
• Methylprednisolone (Medrol, etc.)
• Prednisolone (Prelone, etc.)
• Prednisone (Orasone, etc.)
• Triamcinolone (Aristocort, etc.)

PRECIPITANT DRUGS

Antidepressants:

• Fluvoxamine (Luvox, etc.)
• Nefazodone

Comment:

Inhibition of CYP3A4 by these antidepressants may result in substantial increases in the plasma concentrations of these corticosteroids, even when the corticosteroids are given nasally or by inhalation. This can lead to Cushing's syndrome and adrenal suppression. Although inhaled budesonide or fluticasone are not intended to act systemically, numerous cases have been reported of Cushing's syndrome and adrenal insufficiency due to concurrent use of potent CYP3A4.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative:
• Corticosteroids: Clinical evidence suggests that prednisone and prednisolone are less affected by CYP3A4 inhibitors, but one should still be alert for evidence of corticosteroid toxicity. Theoretically, beclomethasone is unlikely to be affected by CYP3A4 inhibitors.
• Antidepressants: Sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), venlafaxine (Effexor), and paroxetine (Paxil) appear less likely to inhibit CYP3A4 than fluvoxamine. Fluoxetine (Prozac) appears to be a weak inhibitor of CYP3A4, but little is known about the effect of other antidepressants on corticosteroids.
• Monitor: If CYP3A4 inhibitors are used with these corticosteroids, monitor for evidence of corticosteroid toxicity such as hypertension, edema, diabetes, poor wound healing, mood swings, muscle weakness, ocular toxicity, and Cushing's syndrome (moon face, central obesity, bruising, hirsutism, acne).