Case report: fluticasone, fluconazole and ritonavir interactions
This case report further highlights the well documented interaction of a ritonavir-boosted PI and inhaled fluticasone but also describes an added interaction issue with the introduction of fluconazole for oral candidiasis.
Within days of discontinuing fluticasone and initiating fluconazole, the 52 year old man was confirmed with exogenous Cushing’s syndrome and secondary adrenal insufficiency. The authors propose that fluconazole inhibits adrenal steroidogenesis and thereby has an adrenal inhibitory effect.
Source: hiv-druginteractions.org (27 July 2012).
St Clair K, Maguire JD. Role of fluconazole in a case of rapid onset ritonavir and inhaled fluticasone-associated secondary adrenal insufficiency. Int J STD AIDS, 2012, 23(5): 371-372.