Epperla Narendranath, McKiernan Fergus
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI USA.
Center for Bone Disease, Marshfield Clinic, Marshfield, WI USA.
Springerplus. 2015 Aug 27;4:455. doi: 10.1186/s40064-015-1218-x. eCollection 2015.
Ritonavir is a potent inhibitor of the cytochrome P450 enzyme CYP3A4 and is subject to multiple drug-drug interactions. This becomes especially important when the patient is also taking medications metabolized through CYP3A pathway as increased and potentially toxic drug levels may ensue. Herein we present one such interaction wherein a 57 year old gentleman with human immunodeficiency virus (HIV) infection on highly active antiretroviral therapy that included ritonavir, had addition of fluticasone inhaler to his medication repertoire for treatment of chronic obstructive pulmonary disease. This resulted in severe osteoporosis, iatrogenic Cushing syndrome and adrenal insufficiency due to the potentiated systemic glucocorticoid effect of inhaled fluticasone by ritonavir. This case emphasizes the need for pharmacovigilance when managing patients on complex drug regimens for physicians treating HIV infected patients.
利托那韦是细胞色素P450酶CYP3A4的强效抑制剂，会发生多种药物相互作用。当患者同时服用经CYP3A途径代谢的药物时，这一点尤为重要，因为可能会导致药物水平升高并产生潜在毒性。在此，我们介绍这样一种相互作用：一名57岁感染人类免疫缺陷病毒（HIV）的男性，正在接受包含利托那韦的高效抗逆转录病毒治疗，他又添加了氟替卡松吸入剂来治疗慢性阻塞性肺疾病。这导致了严重的骨质疏松、医源性库欣综合征和肾上腺功能不全，原因是利托那韦增强了吸入性氟替卡松的全身糖皮质激素效应。该病例强调，对于治疗HIV感染患者的医生而言，在管理使用复杂药物方案的患者时需要进行药物警戒。
