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Database of Antiretroviral Drug Interactions

Interactions with Fluticasone and Antiretrovirals

Antiretroviral (ARV)Dose of ARVDose of FluticasoneEffect on ARV LevelsEffect on Fluticasone LevelsPotential Clinical EffectsMechanism of InteractionManagement
Atazanavir
(ATV)(Reyataz)
---Increased fluticasone concentrationsDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Use with caution with atazanavir; use with atazanavir/ritonavir is not recommended unless the potential benefit outweighs the risk

Alternative Agents:
Beclomethasone

Darunavir161
(DRV)(Prezista)
---Increased fluticasone concentrationsDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Use with caution; use with darunavir/ritonavir is not recommended unless the potential benefit outweighs the risk

Elvitegravir/cobicistat699
(Genvoya, Stribild)
--- Not studied; possible increased fluticasone levels Possible increased fluticasone effects (eg, Cushing's syndrome, adrenal suppression)-

Consider using alternative corticosteroid such as beclomethasone

Alternative Agents:
Beclomethasone

Elvitegravir/ritonavir-boosted protease inhibitor699
---Not studied; likely increased levels of fluticasone Possible increased fluticasone effects (eg, Cushing's syndrome, adrenal suppression)Inhibition of fluticasone metabolism by CYP3A4

Consider using alternative corticosteroid such as beclomethasone

Alternative Agents:
Beclomethasone

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
---Increased fluticasone concentrationsDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Avoid if possible

Ritonavir55
(RTV)(Norvir)
---Fluticasone AUC: increased 350-fold; Cmax: increased 25-foldDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Avoid if possible

Ritonavir392
(RTV)(Norvir)
100 mg BID x 7 d200 mcg once daily x 7 d-Fluticasone Cmax: increased 2572%; AUC: increased 36697%Increased fluticasone effects (eg, Cushing's syndrome, adrenal suppression)Inhibition of CYP450 3A4 by ritonavir

Dose adjustment not established; use caution

"-" indicates that there are no data available
 55:Norvir [package insert]. North Chicago, IL: Abbott Laboratories, 2008.
 78:Kaletra [package insert]. North Chicago, IL: Abbott Laboratories; Oct 2005.
 161:Prezista [package insert]. Raritan, NJ: Tibotec Therapeutics Inc.; April 2010.
 392:Flonase [package insert]. Research Triangle Park, NC: GlaxoSmith Kline, March 2004.
 699:Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.