There is some evidence that
itraconazole can increase the levels and/or effects of the
active
metabolite of ciclesonide, oral deflazacort,
dexamethasone, methylpredniso-
lone, and to a lesser extent,
prednisolone and
prednisone, as well as inhaled
budesonide and fluticasone. Similarly,
ketoconazole reduces the
metabolism and
clearance of
methylprednisolone, increases the
serum levels of the active
metabolite of
ciclesonide, modestly increases the systemic effect of inhaled
budesonide and possibly
inhaled fluticasone, and markedly increases the AUC of oral
budesonide.
Dose reductions of up to 50% have been recommended if
ketoconazole is given with
methylprednisolone, but it would seem prudent to monitor the outcome of concurrent use of any of the combinations and adjust the dose according to the patients' response. Be alert for evidence of adrenal suppression (e.g. moonface, flushing, increased bruising and acne). The concurrent use of oral
budesonide and
ketoconazole is not recommended by the manufacturers. The manufacturers of ciclesonide suggest that the concurrent use of
ketoconazole or
itraconazole should be avoided unless the benefits outweigh the risks.