Interactions between flonase(fluticasone nasal) and Reyataz (atazanavir)
fluticasone nasal and atazanavir (Moderate Drug-Drug)
GENERALLY AVOID: Coadministration with protease inhibitors, particularly ritonavir, may increase the systemic exposure of fluticasone propionate administered intranasally or by oral inhalation. The mechanism is inhibition of fluticasone metabolism via CYP450 3A4. In 18 healthy subjects, coadministration of fluticasone propionate nasal spray (200 mcg once daily) and ritonavir (100 mg twice daily) for 7 days resulted in dramatic increases in fluticasone propionate plasma levels accompanied by an 86% decrease in mean plasma cortisol AUC compared to administration of the nasal spray alone. Systemic corticosteroid effects such as adrenal suppression, Cushing's syndrome, osteoporosis, and exacerbation of diabetes mellitus have been reported during postmarketing use in patients receiving ritonavir and inhaled or intranasally administered fluticasone propionate.
MANAGEMENT: The use of intranasal or orally inhaled fluticasone in combination with ritonavir is not recommended unless the potential benefit outweighs the risk of systemic side effects. Caution is advised if fluticasone is prescribed with other protease inhibitors (without ritonavir). Alternatives to fluticasone should be considered, particularly for long-term use.
