Hostname: page-component-6766d58669-bkrcr Total loading time: 0 Render date: 2026-05-15T19:05:41.793Z Has data issue: false hasContentIssue false
  • English
  • Français

Prescribing intranasal steroids in HIV-positive patients: systematic review of the literature

Published online by Cambridge University Press:  13 August 2021

N Seymour ,
M Robinson ,
D Richardson ,
H Mohammed ,
D Williams  and
J A McGilligan
N Seymour*
Affiliation:
Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
M Robinson
Affiliation:
Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
D Richardson
Affiliation:
Department of HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
H Mohammed
Affiliation:
Department of HIV Medicine, Chelsea and Westminster NHS Foundation Trust, London, UK
D Williams
Affiliation:
Department of HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
J A McGilligan
Affiliation:
Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
*
Author for correspondence: Ms N Seymour, ENT Department, Royal Sussex County Hospital, Brighton BN2 5BE, UK E-mail: nickyseymour@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There are significant drug–drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome.

Method

All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted.

Results

A literature search and further cross-referencing yielded a total of seven reports on drug–drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019.

Conclusion

The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

Keywords

Drug InteractionsIntranasal AdministrationSteroidsHIVHIV Protease InhibitorsCushing's SyndromeAdrenal Insufficiency

Information

Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 9 , September 2021 , pp. 755 - 758
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.)

Article purchase

Temporarily unavailable

Footnotes

Ms N Seymour takes responsibility for the integrity of the content of the paper

References

Chong, LY, Head, K, Hopkins, C, Philpott, C, Burton, MJ, Schilder, AG. Different types of intranasal steroids for chronic rhinosinusitis. Cochrane Database Syst Rev 2016;(4):CD011993Google ScholarPubMed
BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update). In: https://www.bhiva.org/HIV-1-treatment-guidelines [27 July 2020]Google Scholar
Elliot, ER, Theodoraki, A, Jain, LR, Marshall, NJ, Boffito, M, Baldeweg, SE et al. Iatrogenic Cushing's syndrome due to drug interaction between glucocorticoids and the ritonavir or cobicistat containing HIV therapies. Clin Med 2016;16:412–18CrossRefGoogle ScholarPubMed
HIV and AIDS: Brighton & Hove JSNA topic summary, December 2018. In: http://www.bhconnected.org.uk/sites/bhconnected/files/HIV%20JSNA%20topic%20summary%202018_0.pdf [25 June 2021]Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG;, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097CrossRefGoogle ScholarPubMed
Williams, D, Reicher, I, Mohammed, H, Richardson, D. Secondary adrenal insufficiency from steroid use and co-prescribing of cytochrome p450 3A4 inhibitors. HIV Med 2019;20:e10–11CrossRefGoogle ScholarPubMed
Lewis, J, Turtle, L, Khoo, S, Nsutebu, EN. A case of iatrogenic adrenal suppression after co-administration of cobicistat and fluticasone nasal drops. AIDS 2014;28:2636–7CrossRefGoogle ScholarPubMed
Pereira, MT, Ferreira, L, Horta, A, Carvalho, AC. Exogenous Cushing's syndrome as a result of ritonavir–budesonide interaction. A case report. HIV AIDS Rev 2015;15:91–3CrossRefGoogle Scholar
Deol, S. Intranasal mometasone as an alternative to fluticasone in an HIV patient on ritonavir. Ann Allergy Asthma Immunol 2014;113(suppl 1):68–9Google Scholar
McDonnell, TM. The importance of awareness of ritonavir/cobicistat CYP 34A enzyme inhibition and its effect on steroid metabolism. Ir J Med Sci 2017;186:112–15Google Scholar
Konopnicki, D. Mixed Cushing syndrome and adrenal insufficiency leading to increased deficit in CD4+ cell count in 2 HIV-infected patients treated by nasal fluticasone for chronic sinusitis. Acta Clinica Belgica 2012;67:452Google Scholar
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
Foisy, MM, Yakiwchuk, EM, Chiu, I, Singh, AE. Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature. HIV Med 2008;9:389–96CrossRefGoogle Scholar
Okasaki-Gutierrez, R, Poole, P, Troia-Concio, P, Asmuth, DM. Prevalence of subclinical iatrogenic Cushing's syndrome in patients being co-administered ritonavir and corticosteroids via inhaled, intranasal, and/or topical route [abstract MOPE103]. Washington DC AIDS Conference, 2012Google Scholar
Penzak, SR, Formentini, E, Alfaro, RM. Prednisolone pharmacokinetics in the presence and absence of ritonavir after oral prednisone administration to healthy volunteers. J Acquir Immune Defic Syndr 2005;40:573–80CrossRefGoogle ScholarPubMed
Duman, AK, Fulco, PP. Adrenal insufficiency with voriconazole and inhaled/intranasal corticosteroids: case report and systematic review. J Pharm Pract 2017;30:459–63CrossRefGoogle ScholarPubMed