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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, BrightonBN2 5BE, UK E-mail: nickyseymour@doctors.org.uk
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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
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

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Footnotes

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

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