Fluticasone-Salmeterol/Selected CYP3A4 Inhibitors Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Atazanavir, boceprevir, cobicistat, conivaptan, darunavir, fosamprenavir, idelalisib, indinavir, lopinavir, mibefradil, nefazodone, nelfinavir, ribociclib, ritonavir, saquinavir, telaprevir, tipranavir and tucatinib may slow down how quickly your liver processes fluticasone-salmeterol.
What might happen:
The amount of fluticasone-salmeterol in your blood may increase and cause side effects.
What you should do about this interaction:
Make sure that your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medications together. Let your doctor know right away if you notice any swelling of your face, neck, or trunk; pain in abdomen or back, prolonged sore throat or fever, or mood changes.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Reyataz (atazanavir sulfate) US prescribing information. Bristol-Myers Squibb Company March, 2018.
- 2.Victrelis (boceprevir) US prescribing information. Schering Corporation January, 2017.
- 3.Tybost (cobicistat) US prescribing information. Gilead Sciences, Inc. October, 2019.
- 4.Vaprisol (conivaptan hydrochloride) US prescribing information. Astellas Pharma US, Inc. October, 2016.
- 5.Prezista (darunavir) US prescribing information. Tibotec Inc. May, 2019.
- 6.Lexiva (fosamprenavir calcium) US prescribing information. GlaxoSmithKline March, 2019.
- 7.Crixivan (indinavir sulfate) US prescribing information. Merck & Co., Inc. September, 2016.
- 8.Kaletra (lopinavir/ritonavir tablets) US prescribing information. Abbott Laboratories December, 2019.
- 9.Serzone (nefazodone hydrochloride) US prescribing information. Bristol-Myers Squibb Company January, 2005.
- 10.Viracept (nelfinavir mesylate) US prescribing information. Agouron Pharmaceuticals, Inc. September, 2016.
- 11.Kisqali (ribociclib) US prescribing information. Novartis Pharmaceuticals Corporation January, 2020.
- 12.Norvir (ritonavir) US prescribing information. Abbott Laboratories December, 2019.
- 13.Invirase (saquinavir mesylate) US prescribing information. Roche Laboratories, Inc. March, 2019.
- 14.Incivek (telaprevir) US prescribing information. Vertex Pharmaceuticals Incorporated October, 2013.
- 15.Aptivus (tipranavir) US prescribing information. Boehringer Ingelheim Pharmaceuticals, Inc. June, 2018.
- 16.Advair (fluticasone propionate/salmeterol) US prescribing information. GlaxoSmithKline October, 2008.
- 17.Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, Philippides GJ, Roden DM, Zareba W. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2010 Mar 2;55(9):934-47.
- 18.Kaletra (lopinavir/ritonavir) Canadian prescribing information. Abbott Limited May 22, 2019.
- 19.Norvir (ritonavir) Canadian prescribing information. Abbott May 29, 2019.
- 20.Rouanet I, Peyriere H, Mauboussin JM, Vincent D. Cushing's syndrome in a patient treated by ritonavir/lopinavir and inhaled fluticasone. HIV Med 2003 Apr;4(2):149-50.
- 21.Clevenbergh P, Corcostegui M, Gerard D, Hieronimus S, Mondain V, Chichmanian RM, Sadoul JL, Dellamonica P. Iatrogenic Cushing's syndrome in an HIV-infected patient treated with inhaled corticosteroids (fluticasone propionate) and low dose ritonavir enhanced PI containing regimen. J Infect 2002 Apr;44(3):194-5.
- 22.Chen F, Kearney T, Robinson S, Daley-Yates PT, Waldron S, Churchill DR. Cushing's syndrome and severe adrenal suppression in patients treated with ritonavir and inhaled nasal fluticasone. Sex Transm Infect 1999 Aug; 75(4):274.
- 23.Hillebrand-Haverkort ME, Prummel MF, ten Veen JH. Ritonavir-induced Cushing's syndrome in a patient treated with nasal fluticasone. AIDS 1999 Sep 10;13(13):1803.
- 24.Dupont C, Giraud V, Leporrier J, Greffe S, Rouveix E, Chinet T. Cushing's syndrome induced by combined treatment with inhaled fluticasone and oral ritonavir. Rev Mal Respir 2009 Sep;26(7):779-82.
- 25.Collet-Gaudillat C, Roussin-Bretagne S, Desforges-Bullet V, Petit-Aubert G, Doll J, Beressi JP. Iatrogenic Cushing's syndrome, diabetes mellitus and secondary adrenal failure in a human immunodeficiency virus patient treated with ritonavir boosted atazanavir and fluticasone. Ann Endocrinol (Paris) 2009 Sep;70(4):252-5.
- 26.Valin N, De Castro N, Garrait V, Bergeron A, Bouche C, Molina JM. Iatrogenic Cushing's syndrome in HIV-infected patients receiving ritonavir and inhaled fluticasone: description of 4 new cases and review of the literature. J Int Assoc Physicians AIDS Care (Chic) 2009 Mar-Apr; 8(2):113-21.
- 27.Bouldouyre MA, Moachon L, Guillevin L, Launay O. Iatrogenic Cushing syndrome in an HIV-infected female patient: be careful about interaction inhaled corticosteroids-ritonavir!. Presse Med 2008 Dec;37(12):1834-5.
- 28.Foisy MM, Yakiwchuk EM, Chiu I, Singh AE. Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature. HIV Med 2008 Jul;9(6):389-96.
- 29.Jinno S, Goshima C. Progression of Kaposi sarcoma associated with iatrogenic Cushing syndrome in a person with HIV/AIDS. AIDS Read 2008 Feb;18(2):100-4.
- 30.St Germain RM, Yigit S, Wells L, Girotto JE, Salazar JC. Cushing syndrome and severe adrenal suppression caused by fluticasone and protease inhibitor combination in an HIV-infected adolescent. AIDS Patient Care STDS 2007 Jun;21(6):373-7.
- 31.Bhumbra NA, Sahloff EG, Oehrtman SJ, Horner JM. Exogenous Cushing syndrome with inhaled fluticasone in a child receiving lopinavir/ritonavir. Ann Pharmacother 2007 Jul;41(7):1306-9.
- 32.Pessanha TM, Campos JM, Barros AC, Pone MV, Garrido JR, Pone SM. Iatrogenic Cushing's syndrome in a adolescent with AIDSs on ritonavir and inhaled fluticasone. Case report and literature review. AIDS 2007 Feb 19; 21(4):529-32.
- 33.Arrington-Sanders R, Hutton N, Siberry GK. Ritonavir-fluticasone interaction causing Cushing syndrome in HIV-infected children and adolescents. Pediatr Infect Dis J 2006 Nov;25(11):1044-8.
- 34.Johnson SR, Marion AA, Vrchoticky T, Emmanuel PJ, Lujan-Zilbermann J. Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasone. J Pediatr 2006 Mar;148(3):386-8.
- 35.Gillett MJ, Cameron PU, Nguyen HV, Hurley DM, Mallal SA. Iatrogenic Cushing's syndrome in an HIV-infected patient treated with ritonavir and inhaled fluticasone. AIDS 2005 Apr 29;19(7):740-1.
- 36.Samaras K, Pett S, Gowers A, McMurchie M, Cooper DA. Iatrogenic Cushing's syndrome with osteoporosis and secondary adrenal failure in human immunodeficiency virus-infected patients receiving inhaled corticosteroids and ritonavir-boosted protease inhibitors: six cases. J Clin Endocrinol Metab 2005 Jul;90(7):4394-8.
- 37.Soldatos G, Sztal-Mazer S, Woolley I, Stockigt J. Exogenous glucocorticoid excess as a result of ritonavir-fluticasone interaction. Intern Med J 2005 Jan;35(1):67-8.
- 38.Gupta SK, Dube MP. Exogenous cushing syndrome mimicking human immunodeficiency virus lipodystrophy. Clin Infect Dis 2002 Sep 15; 35(6):E69-71.
- 39.Manchee GR, Eddershaw PJ, Ranshaw LE, Herriott D, Park GR, Bayliss MK, Tarbit MH. The aliphatic oxidation of salmeterol to alpha-hydroxysalmeterol in human liver microsomes is catalyzed by CYP3A. Drug Metab Dispos 1996 May;24(5):555-9.
- 40.Tukysa (tucatinib) US prescribing information. Seattle Genetics April, 2020.
- 41.This information is based on or an extract from the UW Metabolism and Transport Drug Interaction Database (DIDB) Platform, Copyright University of Washington 1999-2019..
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.