Hypothalamic-pituitary-adrenal axis suppression by inhaled or nasal corticosteroids in HIV-infected patients.

Autor: Besemer F; Department of Internal Medicine, Radboudumc Nijmegen, Nijmegen, The Netherlands. fbesemer@gmail.com.; Nij Smellinge Ziekenhuis, Drachten, The Netherlands. fbesemer@gmail.com.; Internal Medicine, Nij Smellinghe, Compagnonsplein 1, 9202 NN, Drachten, the Netherlands. fbesemer@gmail.com., Kramers C; Department of Internal Medicine, Radboudumc Nijmegen, Nijmegen, The Netherlands., Brinkman K; Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands., Hermus ARMM; Department of Internal Medicine, Radboudumc Nijmegen, Nijmegen, The Netherlands., van Herwaarden AE; Department of Laboratory Medicine, Radboudumc Nijmegen, Nijmegen, The Netherlands., Burger DM; Pharmacy Radboudumc Nijmegen, Nijmegen, The Netherlands.
Jazyk: angličtina
Zdroj: International journal of clinical pharmacy [Int J Clin Pharm] 2020 Apr; Vol. 42 (2), pp. 347-350. Date of Electronic Publication: 2020 Mar 05.
DOI: 10.1007/s11096-020-00995-5
Abstrakt: Background Inhaled or nasal corticosteroids can cause suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Early detection is important because this suppression can be associated with significant morbidity. Objective To explore the adverse effect of hypothalamic-pituitary-adrenal suppression by local corticosteroids in HIV-infected patients. Method Ambulatory HIV-infected patients were selected if they used both antiretroviral treatment and inhaled or nasal corticosteroid. Suppression of hypothalamic-pituitary-adrenal axis was defined as a morning plasma cortisol below 80 nmol/L or a cortisol below 550 nmol/L during a 250 mcg adrenocorticotropic hormone-stimulation test. Results Twelve patients were tested; four of them were taking a CYP3A4 inhibitor. All patients had a normal morning plasma cortisol. Suppression of the hypothalamic-pituitary-adrenal axis during the ACTH stimulation test was identified in three of the twelve patients. None of these three individuals were taking a CYP3A4 inhibitor. Conclusion Hypothalamic-pituitary-adrenal axis suppression is frequently identified in patients on inhaled or nasal corticosteroids. CYP3A4 inhibitors such as ritonavir or cobicistat may increase the chance of this adverse effect. In this study we did not identify HPA axis suppression in patients taking CYP3A4 inhibitors. This may be related to the fact that 2 of these 4 patients used beclomethasone, a corticosteroid not metabolized by CYP3A4.ClinicalTrials.gov Identifier NCT02501486.
Databáze: MEDLINE
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