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Drug Interactions between Aristospan and Incivek

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

triamcinolone telaprevir

Applies to: Aristospan (triamcinolone) and Incivek (telaprevir)

MONITOR CLOSELY: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of triamcinolone. No pharmacokinetic data are available. However, there have been numerous published case reports of Cushing's syndrome and adrenal suppression associated with concomitant use of triamcinolone with various ritonavir-containing antiretroviral regimens and one case report with nefazodone.

MANAGEMENT: The possibility of increased corticosteroid effects should be considered when triamcinolone is used with potent CYP450 3A4 inhibitors. Some authorities advise against concomitant use unless the potential benefit outweighs the risk. If coadministration is necessary, a lower dosage of triamcinolone may be appropriate. Patients should be monitored for signs and symptoms of hypercorticism such as acne, striae, thinning of the skin, easy bruising, moon facies, dorsocervical "buffalo" hump, truncal obesity, increased appetite, acute weight gain, edema, hypertension, hirsutism, hyperhidrosis, proximal muscle wasting and weakness, glucose intolerance, exacerbation of preexisting diabetes, depression, and menstrual disorders. Other systemic glucocorticoid effects may include adrenal suppression, immunosuppression, posterior subcapsular cataracts, glaucoma, bone loss, and growth retardation in children and adolescents. Following extensive use with a potent CYP450 3A4 inhibitor, a progressive dosage reduction may be required over a longer period if triamcinolone is to be withdrawn from therapy, as there may be a significant risk of adrenal suppression. Signs and symptoms of adrenal insufficiency include anorexia, hypoglycemia, nausea, vomiting, weight loss, muscle wasting, fatigue, weakness, dizziness, postural hypotension, depression, and adrenal crisis manifested as inability to respond to stress (e.g., illness, infection, surgery, trauma).

References

  1. EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid" (2007):
  2. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  3. Hagan JB, Erickson D, Singh RJ "Triamcinolone Acetonide Induced Secondary Adrenal Insufficiency Related to Impaired CYP3A4 Metabolism by Coadministration of Nefazodone." Pain Med (2010):
  4. Dort K, Padia S, Wispelwey B, Moore CC "Adrenal suppression due to an interaction between ritonavir and injected triamcinolone: a case report." AIDS Res Ther 6 (2009): 10
  5. Levine D, Ananthakrishnan S, Garg A "Iatrogenic Cushing syndrome after a single intramuscular corticosteroid injection and concomitant protease inhibitor therapy." J Am Acad Dermatol 65 (2011): 877-8
  6. Grierson MJ, Harrast MA "Iatrogenic Cushing Syndrome After Epidural Steroid Injections for Lumbar Radiculopathy in an HIV-Infected Patient Treated With Ritonavir: A Case Report Highlighting Drug Interactions for Spine Interventionalists." PM R 4 (2012): 234-7
  7. Albert NE, Kazi S, Santoro J, Dougherty R "Ritonavir and Epidural Triamcinolone as a Cause of Iatrogenic Cushing's Syndrome." Am J Med Sci (2012):
  8. Fessler D, Beach J, Keel J, Stead W "Iatrogenic hypercortisolism complicating triamcinolone acetonide injections in patients with HIV on ritonavir-boosted protease inhibitors." Pain Physician 15 (2012): 489-93
  9. Schwarze-Zander C, Klingmuller D, Klumper J, Strassburg CP, Rockstroh JK "Triamcinolone and ritonavir leading to drug-induced Cushing syndrome and adrenal suppression: description of a new case and review of the literature." Infection (2013):
  10. Hall JJ, Hughes CA, Foisy MM, Houston S, Shafran S "Iatrogenic Cushing syndrome after intra-articular triamcinolone in a patient receiving ritonavir boosted darunavir." Int J STD AIDS (2013):
  11. McConkey HZ, Williams H, Kulasegaram R, Graham E "Orbital floor triamcinolone causing Cushing's syndrome in a patient treated with Kaletra for HIV 1." BMJ Case Rep 2013 (2013):
  12. Sadarangani S, Berg ML, Mauck W, Rizza S "Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review." Interdiscip Perspect Infect Dis 2014 (2014): 849432
View all 12 references

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Drug and food interactions

Moderate

telaprevir food

Applies to: Incivek (telaprevir)

ADJUST DOSING INTERVAL: Food significantly enhances the oral bioavailability of telaprevir. When given with a meal containing 533 kcal and 21 g fat, telaprevir systemic exposure (AUC) increased by 237% compared to administration under fasting conditions. The type of meal also affects the exposure to telaprevir. Relative to fasting, telaprevir AUC increased by approximately 117% with a low-fat meal (249 kcal; 3.6 g fat) and 330% with a high-fat meal (928 kcal; 56 g fat). In Phase 3 clinical trials, telaprevir doses were administered within 30 minutes of completing a meal or snack containing approximately 20 grams of fat.

MANAGEMENT: Telaprevir should be administered with food containing approximately 20 grams of fat. Patients should be advised that the fat content of the meal or snack is critical to the absorption of telaprevir. Food taken with telaprevir should be ingested within 30 minutes prior to each dose. Examples of some foods that could be taken with telaprevir include: bagel with cream cheese; half cup of nuts; 3 tablespoons of peanut butter; 1 cup of ice cream; 2 ounces of American or cheddar cheese; 2 ounces of potato chips; or half cup of trail mix.

References

  1. "Product Information. Incivek (telaprevir)." Vertex Pharmaceuticals (2011):

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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