{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T07:22:45Z","timestamp":1768548165282,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2014,4,23]],"date-time":"2014-04-23T00:00:00Z","timestamp":1398211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:p>Oral budesonide is commonly used for the management of Crohn's disease given its high affinity for glucocorticoid receptors and low systemic activity due to extensive first\u2010pass metabolism through hepatic cytochrome P450 (<jats:styled-content style=\"fixed-case\">CYP<\/jats:styled-content>) 3A4. Voriconazole, a second\u2010generation triazole antifungal agent, is both a substrate and potent inhibitor of <jats:styled-content style=\"fixed-case\">CYP<\/jats:styled-content> isoenzymes, specifically <jats:styled-content style=\"fixed-case\">CYP<\/jats:styled-content>2C19, <jats:styled-content style=\"fixed-case\">CYP<\/jats:styled-content>2C9, and <jats:styled-content style=\"fixed-case\">CYP<\/jats:styled-content>3A4; thus, the potential for drug\u2010drug interactions with voriconazole is high. To our knowledge, drug\u2010drug interactions between voriconazole and corticosteroids have not been specifically reported in the literature. We describe a 48\u2010year\u2010old woman who was receiving oral budesonide 9\u00a0mg\/day for the management of Crohn's disease and was diagnosed with fluconazole\u2010resistant <jats:italic>Candida albicans<\/jats:italic> esophagitis; oral voriconazole 200\u00a0mg every 12\u00a0hours for 3\u00a0weeks was prescribed for treatment. Because the patient experienced recurrent symptoms of dysphagia, a second 3\u2010week course of voriconazole therapy was taken. Seven weeks after originally being prescribed voriconazole, she came to her primary care clinic with elevated blood pressure, lower extremity edema, and weight gain; she was prescribed a diuretic and evaluated for renal dysfunction. At a follow\u2010up visit 6\u00a0weeks later with her specialty clinic, the patient's blood pressure was elevated, and her physical examination was notable for moon facies, posterior cervical fat pad prominence, and lower extremity pitting edema. Iatrogenic Cushing syndrome due to a drug\u2010drug interaction between voriconazole and budesonide was suspected, and voriconazole was discontinued. Budesonide was continued as previously prescribed for her Crohn's disease. On reevaluation 2\u00a0months later, the patient's Cushingoid features had markedly regressed. To our knowledge, this is the first published case report of iatrogenic Cushing syndrome due to a probable interaction between voriconazole and oral budesonide. In patients presenting with Cushingoid features who have received these drugs concomitantly, clinicians should consider the potential drug interaction between these agents, and the risks and benefits of continued therapy must be considered.<\/jats:p>","DOI":"10.1002\/phar.1432","type":"journal-article","created":{"date-parts":[[2014,4,23]],"date-time":"2014-04-23T02:13:05Z","timestamp":1398219185000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Iatrogenic Cushing Syndrome Secondary to a Probable Interaction Between Voriconazole and Budesonide"],"prefix":"10.1002","volume":"34","author":[{"given":"Whitney","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Services Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cody A.","family":"Chastain","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Division of Infectious Diseases Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patty W.","family":"Wright","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Division of Infectious Diseases Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,4,23]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.1996.00493.x"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200443120-00003"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.41.11.2492"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.31.5.540"},{"key":"e_1_2_5_6_1","unstructured":"Pfizer Inc.Vfendpackage insert. 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