https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=9641
https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=9641
No pharmaceutical opinion available for this interaction.
Darunavir / ritonavir can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Budesonide.
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Use an alternative when possible.
NNRTIs, raltegravir, dolutegravir or maraviroc.
Possible increase in adverse effects associated with corticosteroids.
Risk of hypercortisolism. Risk of adrenal insufficiency.
Avoid this association. Use with caution if it can not be avoided.
Use an alternative when possible.
In patients already being treated with this combination and tolerating it, if deemed appropriate, keep actual treatment and exercise close monitoring of adverse effects.
Beclomethasone 100 μg = budesonide 200 μg.
Budesonide toxicity: Cushing's syndrome (moon face, buffalo hump, obesity, striations, acne, hirsutism, hypertension, osteoporosis, glucose intolerance, increased risk of infections) and adrenal suppression (melanodermia, fatigue, weakness, hypotension, weight loss, digestive disorders).
Although budesonide can be an alternative to fluticasone, cases of Cushing's syndrome have also been reported with budesonide. It is recommended to avoid in combination with potent CYP3A4 inhibitors. There is a greater risk with fluticasone because it has the longest glucocorticoid receptor-binding half-life and is 300 times more lipophilic than budesonide.
ACTH
Cortisol (plasma)
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The accumulation of corticosteroids can cause Cushing's syndrome (moon face, excitation/insomnia, hypertension, increased appetite and weight, ease of doing bruising) and potentially a suppression of the hypothalamic-pituitary axis, which could lead to adrenal insufficiency.
Indeed, some cases of Cushing's syndrome and adrenal failure have been reported in the literature with budesonide. See ritonavir and budesonide.
Ref #2807 : A 48-year-old woman with HIV infection developed Cushingoid features while she was taking ritonavir-boosted darunavir. Cushing's syndrome was confirmed due to the drug interaction between ritonavir and budesonide.
The safest corticosteroid is beclomethasone (Qvar) since its metabolism is mainly by an esterification mechanism.
Ref #2550 and #2551 : A cross-sectional study (n = 11 783) suggests lower prevalence of adrenal insufficiency with beclomethasone than with other corticosteroids currently available on the market. Pharmacokinetic studies with beclomethasone and ritonavir or combination darunavir/ritonavir demonstrated that there were no clinically significant pharmacokinetic interactions. No variation of blood cortisol have been observed.
Budesonide should not be stopped without consultation with a physician. If the axis hypothalamo-hypophyseal is eliminated, stopping suddenly budesonide can lead to signs and symptoms of adrenal incapacity. It is recommended to decrease slowly the corticosteroid to avoid the symptoms of craving (fatigue, loss of weight, intoxications, weakness, low postural blood pressure and acute adrenal crisis). Plasma cortisol and ACTH test will document the presence or absence of adrenal insufficiency.