Kaletra and Xhance Nasal Spray

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Talk to your doctor before using ritonavir together with fluticasone nasal. Combining these medications may increase the absorption of fluticasone nasal into the blood stream. You may be more likely to experience side effects such as swelling, weight gain, high blood pressure, high blood glucose, muscle weakness, depression, acne, thinning skin, stretch marks, easy bruising, bone density loss, cataracts, menstrual irregularities, excessive growth of facial or body hair, and abnormal distribution of body fat, especially in the face, neck, back, and waist. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Other side effects that may occur include decreased ability to fight infections, increased risk of developing infections, and inadequate response to stress such as infection, surgery, trauma, or a severe asthma attack. Children may experience a reduced growth rate due to excessive effects of fluticasone nasal. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

GENERALLY AVOID: Coadministration with ritonavir may significantly increase the systemic exposure to fluticasone following intranasal administration or oral inhalation. The mechanism is ritonavir inhibition of fluticasone metabolism via hepatic and intestinal CYP450 3A4. In 18 healthy subjects, administration of fluticasone propionate nasal spray (200 mcg once daily) in combination with ritonavir (100 mg twice daily) for 7 days resulted in an approximately 25-fold increase in fluticasone peak plasma concentration (Cmax) and 350-fold increase in systemic exposure (AUC) compared to administration alone. These changes were accompanied by an 86% decrease in mean plasma cortisol AUC. Systemic glucocorticoid adverse effects such as adrenal suppression, Cushing's syndrome, osteoporosis, and exacerbation of diabetes mellitus have been reported during postmarketing use of orally inhaled or intranasal fluticasone in patients receiving ritonavir-containing antiretroviral regimens. In an analysis of 25 suspected cases of the interaction reported in the medical literature, the mean dosage of orally inhaled fluticasone was 992 mcg/day (range 500 to 2000 mcg/day) in adult cases and 455 mcg/day (range 200 to 1000 mcg/day) in pediatric cases. Dosages of ritonavir used included both low, "boosting" dosages (100 to 200 mg daily) and high, "treatment" dosages (800 to 1200 mg/day). The average onset of cushingoid appearance was approximately 2.75 months (range 2 weeks to 6 months) in adult cases and 2.1 months (range 2 weeks to 3 months) in pediatric cases. For the three cases involving intranasal fluticasone, the dosage used ranged from 200 to 800 mcg/day and the onset of cushingoid appearance ranged from 5 to 18 months of concomitant use with ritonavir. Recovery of adrenal function was reportedly slow in some patients following discontinuation of fluticasone. Investigators suggest that this could be related to the highly lipophilic nature of fluticasone, which allows for prolonged seepage of drug into the circulation from fat stores.

MANAGEMENT: The use of intranasal or orally inhaled fluticasone in combination with ritonavir is not recommended unless the potential benefit outweighs the risk of systemic side effects. Alternatives to fluticasone should be considered whenever possible if ritonavir must be used. A less potent, less lipophilic, and/or shorter-acting agent such as beclomethasone, budesonide, flunisolide or triamcinolone may be appropriate, although probably most, if not all, corticosteroids can interact with ritonavir to some extent. The lowest effective dosage of orally inhaled corticosteroid should be used, and further adjustments made as necessary according to therapeutic response and tolerance. Patients should be monitored for signs and symptoms of hypercorticism such as acne, striae, thinning of the skin, easy bruising, moon facies, dorsocervical "buffalo" hump, truncal obesity, increased appetite, acute weight gain, edema, hypertension, hirsutism, hyperhidrosis, proximal muscle wasting and weakness, glucose intolerance, exacerbation of preexisting diabetes, depression, and menstrual disorders. It is important to distinguish between hypercorticism and the lipodystrophy syndrome caused by antiretroviral treatment, as the overlap of certain clinical features may delay the recognition and diagnosis of Cushing's syndrome. In general, the lack of peripheral atrophy and the presence of abdominal striae, easy bruising, and facial plethora would suggest iatrogenic Cushing's syndrome rather than antiretroviral-related lipodystrophy. Other systemic glucocorticoid effects may include adrenal suppression, immunosuppression, posterior subcapsular cataracts, glaucoma, bone loss, and growth retardation in children and adolescents. Following extensive use with ritonavir, a progressive dosage reduction may be required over a longer period if fluticasone is to be withdrawn from therapy, as there may be a significant risk of adrenal suppression. Signs and symptoms of adrenal insufficiency include anorexia, hypoglycemia, nausea, vomiting, weight loss, muscle wasting, fatigue, weakness, dizziness, postural hypotension, depression, and adrenal crisis manifested as inability to respond to stress (e.g., illness, infection, surgery, trauma). Systemic glucocorticoids may be necessary until adrenal function recovers.

Kaletra

Generic Name: lopinavir / ritonavir

Brand name: Kaletra

Synonyms: n.a.

What is Kaletra?

Xhance Nasal Spray

Generic Name: fluticasone nasal

Brand name: Flonase, Veramyst, Xhance, Childrens Flonase, Flonase Sensimist, Good Sense Nasoflow, Flonase Allergy Relief, GoodSense Nasoflow

Synonyms: Fluticasone nasal, Fluticasone (Nasal)

What is Xhance Nasal Spray?