Corticosteroids & ARVs

Legend

↑  Potential increased exposure of the corticosteroid 
↓  Potential decreased exposure of the corticosteroid
↔ No significant effect
D  Potential decreased exposure of ARV drug
E  Potential elevated exposure of ARV drug

ATV/c    ATV co-formulated with COBI (300/150 mg qd);
DRV/c    DRV co-formulated with COBI (800/150 mg qd)

Numbers refer to increased or decreased AUC as observed in drug-drug interaction studies

Interactions with ZDV
No clinically relevant interactions expected with ZDV and corticosteroids

Comments

1. Co-administration of RTV (100 mg bid) increased the concentrations of the active metabolite (beclometasone-17-monopropionate) but no significant effect on adrenal function was seen. Caution is still warranted, use the lowest possible corticosteroid dose and monitor for corticosteroid side effects
2. DRV/r decreased the exposure of active metabolite (beclometasone-17-monopropionate), no significant effect on adrenal function was seen
3. Risk of having elevated corticosteroid levels, Cushing's syndrome and adrenal suppression. This risk is present for oral and injected corticosteroid but also for topical, inhaled or eye drops administration
4. No dose adjustment required but monitor closely, especially for signs of Cushing's syndrome when using a high dose or prolonged administration
5. The extent of percutaneous absorption is determined by many factors such as degree of inflammation and alteration of the skin, duration, frequency and surface of application, use of occlusive dressings
6. Use the lowest possible flunisolide dose with monitoring for corticosteroid side effects
   
   

Further Information

For additional drug-drug interactions and for more detailed pharmacokinetic interaction data and dosage adjustments, please refer to http://www.hiv-druginteractions.org (University of Liverpool).