Drug Interaction Report
1 potential interaction and/or warning found for the following 2 drugs:
- Flovent Rotadisk (fluticasone)
- letermovir
Interactions between your drugs
fluticasone letermovir
Applies to: Flovent Rotadisk (fluticasone), letermovir
MONITOR: Coadministration with moderate inhibitors of CYP450 3A4 may increase the systemic exposure to fluticasone following intranasal administration or oral inhalation. Fluticasone undergoes extensive first-pass and systemic metabolism via CYP450 3A4, thus inhibition of the isoenzyme may significantly increase systemic bioavailability of the drug. However, the extent of interaction may depend on the route of fluticasone administration and the specific formulation. Multiple case reports describe instances of adrenal insufficiency and Cushing's syndrome associated with concomitant use of inhaled fluticasone and the azole antifungal fluconazole, a moderate CYP450 3A4 inhibitor.
MANAGEMENT: Monitor for signs and symptoms of hypercorticism if intranasal or orally inhaled fluticasone is coadministered with a moderate inhibitor of CYP450 3A4. Signs and symptoms of hypercorticism include 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. 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). Systemic glucocorticoids may be necessary until adrenal function recovers.
References
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- (2006) "Product Information. Prezista (darunavir)." Ortho Biotech Inc
- Cerner Multum, Inc. "Australian Product Information."
- Hoover WC, Britton LJ, Gardner J, Jackson T, Gutierrez H (2011) "Rapid onset of iatrogenic adrenal insufficiency in a patient with cystic fibrosis-related liver disease treated with inhaled corticosteroids and a moderate CYP3A4 inhibitor." Ann Pharmacother, 45, e38
- (2012) "Product Information. Bosulif (bosutinib)." Pfizer U.S. Pharmaceuticals Group
- St Clair K, Maguire JD (2012) "Role of fluconazole in a case of rapid onset ritonavir and inhaled fluticasone-associated secondary adrenal insufficiency." Int J STD AIDS, 23, p. 371-2
- (2013) "Product Information. Imbruvica (ibrutinib)." Pharmacyclics Inc
Drug and food interactions
No alcohol/food interactions were found with the drugs in your list. However, this does not necessarily mean no food interactions exist. Always consult your healthcare provider.
Therapeutic duplication warnings
No duplication 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.
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
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Further information
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