Date of report: 27 Jun 2019
Reported case interaction between
 Cobicistat and Triamcinolone

FLS Science

Drugs suspected to be involved in the DDI

Drug A
Cobicistat (Perpetrator)
Daily Dose
150 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Feb. 4, 2016
End date
Oct. 21, 2016
Drug B
Triamcinolone (Victim)
Daily Dose
Unknown
Dose adjustment performed
No
Administration Route
Other
Start date
Sept. 21, 2016
End date
Sept. 21, 2017

Complete list of drugs taken by the patient

Antiretroviral treatment
Darunavir/Cobicistat
Complete list of all comedications taken by the patient, included that involved in the DDI
Triamcinolone (single dose), omeprazol (occasionally)

Clinical case description

Gender
Female
Age
47
eGFR (mL/min)
>60
Liver function impairment
No
Description
This patient was on ART with darunavir/cobicistat monotherapy. She received a local triamcinolone acetonide injection because of shoulder tendonitis. Two weeks later the patient presented with Cushing syndrome. ART was switched to ABC/3TC/DTG. In order to prevent adrenal insufficiency, hydrocortisone replacement was initiated at the same moment when ART was changed. Complete clinical restoration was observed after 4 months. At that moment hydrocortisone dose tapering was initiated and it was completely stopped one month later.

Outcome

Toxicity

Drug Interaction Probability Scale (DIPS)

Score
7 - Probable

Editorial Comment

This is a nice case of a known DDI that emphasize the role of booster regimens in favoring exogenous Cushing syndrome. The strategy of changing HAART as well as replacing the corticosteroid seem rational and was effective in this patient.