17
Factors increasing the risk of
glucocorticoid-induced adrenal
insufficiency
Strategies to mitigate the risk of
glucocorticoid-induced adrenal
insufficiency
4
• Treatment with high doses
2
for prolonged
periods
• Use of fluticasone propionate
• Concomitant use of other glucocorticoid
formulations (e.g., oral glucocorticoids
in chronic obstructive pulmonary disease
or nasal glucocorticoids for rhinitis/nasal
polyposis)
• Lower body mass index
• Higher compliance with treatment
• Concomitant treatment with strong
cytochrome P450 3A4 inhibitors
3
(e.g.,
medications containing ritonavir; antifungal
drugs for acute allergic bronchopulmonary
aspergillosis)
• Use the lowest effective
glucocorticoid dose for the shortest
period
• Use spacers and mouth rinsing
• Consider alternative
glucocorticoids to fluticasone
propionate
• Avoid co-administration with
strong cytochrome P450 3A4
inhibitors
3
• Repeated injections over a short period
(<3 months)
• Simultaneous injections of multiple joints
• Use of high glucocorticoid doses
• Inflammatory arthropathies
• Concomitant use of other glucocorticoid
formulations
• Concomitant treatment with strong
cytochrome P450 3A4 inhibitors
3
• Reduce the number of injections,
if possible
• Space out injections by at least 3–4
months, if possible
• Triamcinolone hexacetonide
may carry a lower risk of systemic
absorption than triamcinolone
acetonide
• Avoid co-administration with
strong cytochrome P450 3A4
inhibitors
3
