More on Protease Inhibitors and Corticosteroids
May 18, 2012
It has been demonstrated previously that ritonavir significantly increases serum levels of inhaled and intranasal fluticasone and that coadministration with fluticasone should be avoided. Few studies have examined interactions between PIs and other corticosteroids. At the 19th Conference on Retroviruses and Opportunistic Infections, researchers presented results from a randomized controlled PK study of interactions of both darunavir/ritonavir and ritonavir (alone) with inhaled beclomethasone.
In the study, 30 subjects received 160 mcg of inhaled beclomethasone BID; after 2 weeks, 10 subjects added darunavir/ritonavir 600 mg/100 mg BID, 10 added ritonavir 100 mg BID, and the remaining 10 continued beclomethasone alone. At study day 28, there was no significant change in the geometric mean ratio for AUC or Cmax of the beclomethasone active metabolite with or without darunavir/ritonavir. In the ritonavir group, the AUC of the beclomethasone metabolite increased by 2 times.
Clinical Bottom Line
This study suggests that the use of beclomethasone with boosted protease inhibitors is relatively safe and not likely to cause systemic corticosteroid-associated adverse effects. A concurrent study by the same authors  confirmed that coadministration of inhaled beclomethasone with either darunavir/ritonavir or ritonavir alone 100 mg BID did not result in significant adrenal suppression.
- Boyd S, Hadigan C, Pau A, et al. Darunavir/ritonavir does not significantly increase plasma concentrations of orally inhaled beclomethasone in healthy volunteers. In: Program and abstracts of the 19th Conference on Retroviruses and Opportunistic Infections; March 5-8, 2012; Seattle. Abstract 611.
- Boyd S, Penzak S, Nieman L, et al. Co-administration of orally inhaled beclomethasone dipropionate and HIV protease inhibitor does not significantly alter adrenal function in healthy volunteers. In: Program and abstracts of the 19th Conference on Retroviruses and Opportunistic Infections; March 5-8, 2012; Seattle. Abstract 610.
Susa Coffey is medical editor of the NCRC. She is a Professor of Medicine at UCSF in the Division of HIV, Infectious Diseases and Global Medicine and a longtime clinician and educator in the HIV at San Francisco General Hospital clinic (“Ward 86”). She also is medical editor of HIV InSite.