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Triamcinolone acetonide induced secondary adrenal insufficiency related to impaired CYP3A4 metabolism by coadministration of nefazodone.

Author(s): Hagan JB, Erickson D, Singh RJ

Affiliation(s): Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. hagan.john@mayo.edu

Publication date & source: 2010-07, Pain Med., 11(7):1132-5. Epub 2010 Apr 29.

Publication type: Case Reports

OBJECTIVE: This case report seeks to promote physician awareness of the potential drug interaction between corticosteroid medications and cytochrome P450 3A4 (CYP3A4) inhibitors. SETTING: Tertiary care multispecialty referral center. DISCUSSION: Corticosteroid injections are commonly used as effective treatments for a variety of pain disorders. Recently, there has been a greater appreciation of the potential drug interactions between CYP3A4 inhibitors and corticosteroid medications including topical steroid preparations. We report a case of triamcinolone acetonide induced secondary adrenal insufficiency related to impaired CYP3A4 metabolism by coadministration of nefazodone. CONCLUSION: Physicians should recognize the potential effects of CYP3A4 inhibitors particularly when administering or prescribing systemic corticosteroid medications.

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