How do corticosteroids and protease inhibitors (PIs) interact?

Updated: Jan 15, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michelle R Salvaggio, MD, FACP  more...
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Coadministration of inhaled beclomethasone with DRV/r may affect drug levels; RTV 100 mg BID increases 17-BMP AUC 2-fold and Cmax 1.6-fold; DRV 600 mg BIV plus RTV 100 mg BID decreases 17-BMP AUC 11% and Cmax 19%; no dosage adjustment necessary; significant interaction with other boosted PIs not expected.

Dexamethasone in combination with all PIs can decrease PI drug levels; use dexamethasone with caution, or consider an alternative corticosteroid for long-term use.

Fluticasone (inhaled or intranasal) or budesonide (inhaled or intranasal) should not be coadministered with RTV-boosted PIs unless the potential benefit outweighs the risk of systemic corticosteroid adverse effects (adrenal insufficiency, Cushing syndrome). [17]

Increased prednisolone levels possible when prednisone is coadministered with PIs; prednisone and LPV/RTV coadministration results in 31% increase in prednisolone AUC and a decrease in LPV levels; should not be coadministered unless the potential benefit of prednisone outweighs the risk of systemic corticosteroid adverse effects.

Local injections (including intra-articular, epidural, intra-orbital) of methylprednisolone, prednisolone, or triamcinolone coadministered with all RTV-boosted PIs is expected to increase glucocorticoid levels; coadministration may result in adrenal insufficiency, including Cushing syndrome; do not coadminister; consider alternative nonsteroidal therapies; if intra-articular corticosteroid therapy required, change to alternative non-CYP3A-modulating ART (eg, RAL, DTG).

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