Selected Corticosteroids/Selected Azole Antifungal Agents 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.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Itraconazole, ketoconazole, posaconazole, or voriconazole may slow down how quickly your body processes your corticosteroid.

What might happen:

The levels of corticosteroid in your blood may increase.

What you should do about this interaction:

Tell your healthcare professional (e.g. doctor or pharmacist) that you are taking both of these medicines. Your doctor may wish to change the dose of your medicine or change your medicine. Let your doctor know right away if you notice any swelling of your face, neck, or trunk; pain in the 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.

View Reference
  • 1.Raaska K, Niemi M, Neuvonen M, Neuvonen PJ, Kivisto KT. Plasma concentrations of inhaled budesonide and its effects on plasma cortisol are increased by the cytochrome P4503A4 inhibitor itraconazole. Clin Pharmacol Ther 2002 Oct;72(4):362-9.
  • 2.Skov M, Main KM, Sillesen IB, Muller J, Koch C, Lanng S. Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide. Eur Respir J 2002 Jul;20(1):127-33.
  • 3.Bolland MJ, Bagg W, Thomas MG, Lucas JA, Ticehurst R, Black PN. Cushing's syndrome due to interaction between inhaled corticosteroids and itraconazole. Ann Pharmacother 2004 Jan;38(1):46-9.
  • 4.Main KM, Skov M, Sillesen IB, Dige-Petersen H, Muller J, Koch C, Lanng S. Cushing's syndrome due to pharmacological interaction in a cystic fibrosis patient. Acta Paediatr 2002;91(9):1008-11.
  • 5.De Wachter E, Malfroot A, De Schutter I, Vanbesien J, De Schepper J. Inhaled budesonide induced Cushing's syndrome in cystic fibrosis patients, due to drug inhibition of cytochrome P450. J Cyst Fibros 2003 Jun; 2(2):72-5.
  • 6.Entocort HC (budesonide) US prescribing information. AstraZeneca AB June, 2009.
  • 7.Seidegard J. Reduction of the inhibitory effect of ketoconazole on budesonide pharmacokinetics by separation of their time of administration. Clin Pharmacol Ther 2000 Jul;68(1):13-7.
  • 8.Parmar JS, Howell T, Kelly J, Bilton D. Profound adrenal suppression secondary to treatment with low dose inhaled steroids and itraconazole in allergic bronchopulmonary aspergillosis in cystic fibrosis. Thorax 2002 Aug;57(8):749-50.
  • 9.Woods DR, Arun CS, Corris PA, Perros P. Cushing's syndrome without excess cortisol. BMJ 2006 Feb 25;332(7539):469-70.
  • 10.Varis T, Kivisto KT, Backman JT, Neuvonen PJ. The cytochrome P450 3A4 inhibitor itraconazole markedly increases the plasma concentrations of dexamethasone and enhances its adrenal-suppressant effect. Clin Pharmacol Ther 2000 Nov;68(5):487-94.
  • 11.Lebrun-Vignes B, Archer VC, Diquet B, Levron JC, Chosidow O, Puech AJ, Warot D. Effect of itraconazole on the pharmacokinetics of prednisolone and methylprednisolone and cortisol secretion in healthy subjects. Br J Clin Pharmacol 2001 May;51(5):443-50.
  • 12.Linthoudt H, Van Raemdonck D, Lerut T, Demedts M, Verleden G. The association of itraconazole and methylprednisolone may give rise to important steroid-related side effects. J Heart Lung Transplant 1996 Nov; 15(11):1165.
  • 13.Glynn AM, Slaughter RL, Brass C, D'Ambrosio R, Jusko WJ. Effects of ketoconazole on methylprednisolone pharmacokinetics and cortisol secretion. Clin Pharmacol Ther 1986 Jun;39(6):654-9.
  • 14.Kandrotas RJ, Slaughter RL, Brass C, Jusko WJ. Ketoconazole effects on methylprednisolone disposition and their joint suppression of endogenous cortisol. Clin Pharmacol Ther 1987 Oct;42(4):465-70.
  • 15.Yamashita SK, Ludwig EA, Middleton E Jr, Jusko WJ. Lack of pharmacokinetic and pharmacodynamic interactions between ketoconazole and prednisolone. Clin Pharmacol Ther 1991 May;49(5):558-70.
  • 16.Varis T, Kivisto KT, Neuvonen PJ. The effect of itraconazole on the pharmacokinetics and pharmacodynamics of oral prednisolone. Eur J Clin Pharmacol 2000 Apr;56(1):57-60.
  • 17.Omnaris (ciclesonide) US prescribing information. Nycomed US Inc. November 20, 2007.
  • 18.Dulera (mometasone furoate/formoterol) US prescribing information. Merck & Co., Inc. August, 2019.
  • 19.Kempsford R, Allen A, Bal J, Rubin D, Tombs L. The effect of ketoconazole on the pharmacokinetics and pharmacodynamics of inhaled fluticasone furoate and vilanterol trifenatate in healthy subjects. Br J Clin Pharmacol 2013 Jun;75(6):1478-87.
  • 20.Flovent Diskus (fluticasone propionate) US prescribing information. GlaxoSmithKline January, 2019.
  • 21.Jones W, Chastain CA, Wright PW. Iatrogenic cushing syndrome secondary to a probable interaction between voriconazole and budesonide. Pharmacotherapy 2014 Jul;34(7):e116-9.
  • 22.Duman AK, Fulco PP. Adrenal Insufficiency With Voriconazole and Inhaled/Intranasal Corticosteroids: Case Report and Systematic Review. J Pharm Pract 2016 May 04.
  • 23.Pilmis B, Coignard-Biehler H, Jullien V, Hermine O, Touraine P, Lecuit M, Lortholary O. Iatrogenic Cushing's syndrome induced by posaconazole. Antimicrob Agents Chemother 2013 Nov;57(11):5727-8.
Full Drug Information

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

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.