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Complications of combination intranasal corticosteroids and anti-retroviral therapy

Published online by Cambridge University Press:  28 September 2021

J James ,
L Caulley ,
J Collins  and
C Hopkins
J James
Affiliation:
City University of New York School of Medicine, USA
L Caulley
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Ottawa, Ottawa Hospital, Canada Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Canada Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
J Collins
Affiliation:
ENT Department, Guy's Hospital, London, UK
C Hopkins*
Affiliation:
ENT Department, Guy's Hospital, London, UK
*
Author for correspondence: Professor Claire Hopkins, ENT Department, Guy's Hospital, Great Maze Pond, LondonSE1 9RT, UK E-mail: Claire.Hopkins@gstt.nhs.uk
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Abstract

Background

Intranasal corticosteroids are widely used for management of many upper airway diseases because of their ability to effectively deliver local relief of inflammation.

Case report

This paper presents the case of a 51-year-old man with human immunodeficiency virus treated with ritonavir who was started on fluticasone intranasal spray for presumed chronic rhinosinusitis. Months after starting this therapy, he developed symptoms of Cushing's syndrome and avascular necrosis of the shoulder due to the pharmacological interactions between fluticasone and ritonavir.

Conclusion

Although intranasal corticosteroids are deemed a low-risk route of drug administration, clinicians need to be vigilant in appropriately prescribing corticosteroids in the setting of drug potentiators, particularly in these high-risk patients. Alternative corticosteroids such as beclomethasone dipropionate should be considered in such cases.

Keywords

FluticasoneCushing SyndromeOsteonecrosisSinusitisHIVDrug InteractionsRitonavir
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 12 , December 2021 , pp. 1119 - 1122
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Prof C Hopkins takes responsibility for the integrity of the content of the paper

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