Several cases of Cushing's
syndrome have been seen in patients taking inhaled or intranasal fluticasone with
ritonavir. Ritonavir may reduce the clearance of
prednisone, and
ritonavir or nelfinavir may increase levels of the active
metabolite of ciclesonide. The manufacturers of
betamethasone and
budesonide predict a similar interaction with
ritonavir or nelfinavir. Dexamethasone may reduce the levels of indinavir and saquinavir.
Monitor concurrent use for signs of corticosteroid overdose such as fluid retention, hypertension and hyperglycaemia. The problem may take months to manifest itself with inhaled
corticosteroids. Monitor
antiviral efficacy if
dexamethasone is given with indinavir or saquinavir.