No pharmaceutical opinion available for this interaction.
Atazanavir / ritonavir can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Mometasone.
3A4, P-gp/3A4 > 2D6, P-gp
Ritonavir: 1A2, 2C9, 2C19, UGT, 2B6, 3A4 (auto-induction)
3A4, UGT1A1, P-gp E et 2C8/3A4 > 2D6 > 2A6, 2E1, P-gp, MRP2
Possible increase of adverse effects.
Avoid association. Choose an alternative.
Beclomethasone 100 μg = mometasone 200 μg.
Mometasone 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).
Ref #3412 : Case report of a 54 year-old VIH+ woman on tenofovir, raltegravir and darunavir/ritonavir who developed severe unrecognized exogenous Cushing’s syndrome from the concomitant administration with the potent inhaled glucocorticoid mometasone.
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.
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.