Triamcinolone acetonide induced secondary adrenal insufficiency related to impaired cyp3a4 metabolism by coadministration of nefazodone

Abstract

Objective. This case report seeks to promote physician awareness of the potential drug interaction between corticosteroid medications and cytochrome P450 3A4 (CYP3A4) inhibitors. Setting. Tertiary care multispecialty referral center. Discussion. Corticosteroid injections are commonly used as effective treatments for a variety of pain disorders. Recently, there has been a greater appreciation of the potential drug interactions between CYP3A4 inhibitors and corticosteroid medications including topical steroid preparations. We report a case of triamcinolone acetonide induced secondary adrenal insufficiency related to impaired CYP3A4 metabolism by coadministration of nefazodone. Conclusion. Physicians should recognize the potential effects of CYP3A4 inhibitors particularly when administering or prescribing systemic corticosteroid medications. © 2010 American Academy of Pain Medicine.