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Itraconazole-corticosteroid interaction — GPhC CRA MCQ

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HardDrug InteractionsItraconazole-corticosteroid interactionGPhC CRA

A 45-year-old man on regular prednisolone 10 mg daily for COPD presents with a new prescription for itraconazole 200 mg once daily for a fungal nail infection. The pharmacist checks for interactions. What is the most important concern?

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Correct answer: B — Itraconazole inhibits CYP3A4 and can increase prednisolone exposure, potentially causing Cushingoid side effects

Itraconazole is a potent CYP3A4 inhibitor. Prednisolone is partially metabolised by CYP3A4, and concurrent use can increase corticosteroid exposure, potentially leading to adrenal suppression and Cushingoid side effects. The BNF lists this as an interaction to be aware of. The prescriber should be informed and the patient monitored for signs of excessive corticosteroid effects. A lower dose of prednisolone or an alternative antifungal may be considered.

Reference: BNF Drug Interactions