Interaksjonssøk

Relevans
Forholdsregler bør tas

Situasjonskriterium
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Klinisk konsekvens
Økt konsentrasjon av prednison/prednisolon (motstridende data; fra ingen økning i noen studier til 20-60 % økning i andre studier, alle med ulike kraftige enzyminduktorer som ketokonazol, itrakonazol, ritonavir og klaritromycin).

Interaksjonsmekanisme
Mulig hemming av metabolismen av prednison/prednisolon via CYP3A4.

Dosetilpasning
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Justering av doseringstidspunkt
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Monitorering
Pasienten bør følges opp med tanke på bivirkninger av prednison/prednisolon og dosen av prednison/prednisolon eventuelt reduseres.

Legemiddelalternativer
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Kildegrunnlag
Indirekte data

Kilder
Zürcher RM, Frey BM, Frey FJ. Impact of ketoconazole on the metabolism of prednisolone. Clin Pharmacol Ther 1989; 45: 366–72.

Yamashita SK, Ludwig EA, Middleton E et al. Lack of pharmacokinetic and pharmacodynamic interactions between ketoconazole and prednisolone. Clin Pharmacol Ther 1991; 49: 558–70.

Ludwig EA, Slaughter RL, Savliwala M et al. Steroid-specific effects of ketoconazole on corticosteroid disposition: unaltered prednisolone elimination. DICP 1989; 23: 858–61.

Denning DW, Van Wye JE, Lewiston NJ et al. Adjunctive therapy of allergic bronchopulmonary aspergillosis with itraconazole. Chest 1991; 100: 813–9.

Varis T, Kivistö KT, Neuvonen PJ. The effect of itraconazole on the pharmacokinetics and pharmacodynamics of oral prednisolone. Eur J Clin Pharmacol 2000; 56: 57–60.

Lebrun-Vignes B, Archer VC, Diquet B et al. Effect of itraconazole on the pharmacokinetics of prednisolone and methylprednisolone and cortisol secretion in healthy subjects. Br J Clin Pharmacol 2001; 51,: 443–50.

Penzak SR, Formentini E, Alfaro RM et al. Prednisolone pharmacokinetics in the presence and absence of ritonavir after oral prednisone administration to healthy volunteers. J Acquir Immune Defic Syndr 2005; 40: 573–80.

Busse KH, Formentini E, Alfaro RM, Kovacs JA, Penzak SR. Influence of antiretroviral drugs on the pharmacokinetics of prednisolone in HIV-infected individuals. J Acquir Immune Defic Syndr 2008); 48: 561–6.

Finkenbine RD, Frye MD. Case of psychosis due to prednisone-clarithromycin interaction. Gen Hosp Psychiatry 1998; 20: 325–6.