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Asthma: Potential ARV Interactions

for Health Care Providers

Table 4: Potential ARV Interactions

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Inhaled Corticosteroids

Fluticasone:

  • PIs: caution: ↑ serum fluticasone levels; can cause systemic corticosteroid side effects, including Cushing syndrome
    • Avoid (or limit) use with RTV, particularly in the LPV/r, ATV/r, and DRV/r combinations
    • Even boosting dosages of RTV (eg, 100 mg BID) may ↑ serum fluticasone Cmax by 2,500%
    • ATV: can ↑ fluticasone levels - use with caution
    • It is unclear whether significant interactions occur between other inhaled steroids and PIs
  • NRTIs, NNRTIs: no significant interactions expected

Long-Acting Beta Agonists

  • CYP 3A4 inhibitors such as RTV may ↑ salmeterol levels

Theophylline

  • RTV: ↓ theophylline AUC
  • IDV: small ↑ in theophylline AUC
  • Monitor and adjust theophylline dosing as needed

Leukotriene receptor antagonists

  • Zafirlukast may inhibit CYP 3A4 and 2C9, potentially interacting with PIs (no formal studies); monitor clinically for adverse effects. Montelukast has not been shown to inhibit CYP 3A4.

From Asthma
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009