Corticosteroid · Anti-inflammatory
Corticosteroids enter target cells and bind to glucocorticoid receptors (GRs) in the cytoplasm. The steroid-GR complex moves into the nucleus, binding to specific DNA sequences to increase or decrease gene transcription, or interacting with protein transcription factors (e.g., AP-1, NF-κB) and coactivators. This suppresses inflammation by inhibiting inflammatory genes, preventing inflammatory cell recruitment, inhibiting cytokine formation, decreasing eosinophil survival, preventing vascular permeability, and inhibiting mucus secretion.
High risk of systemic corticosteroid effects, including Cushing's syndrome and adrenal suppression.
Concomitant use is generally not recommended. If unavoidable, consider alternative corticosteroids or close monitoring for systemic effects and dose reduction of fluticasone propionate. The manufacturer of cobicistat-containing products often advises against co-administration with inhaled/intranasal fluticasone.
Increased risk of systemic corticosteroid effects, including Cushing's syndrome, adrenal suppression, hyperglycemia, glaucoma, and cataracts.
Concomitant use is generally contraindicated due to the high risk of severe systemic corticosteroid effects. If unavoidable, consider alternative corticosteroids or close monitoring for systemic effects and dose reduction of fluticasone propionate.
Potential for increased systemic corticosteroid effects, particularly with high doses of fluticasone or prolonged co-administration. Effects may include adrenal suppression or hyperglycemia.
Use with caution. Monitor for signs of systemic corticosteroid effects. Consider reducing the dose of fluticasone propionate if systemic effects are observed.
Potential for increased systemic corticosteroid effects, particularly with high doses of fluticasone or prolonged co-administration. Effects may include adrenal suppression or hyperglycemia.
Use with caution. Monitor for signs of systemic corticosteroid effects. Consider using an alternative macrolide antibiotic (e.g., azithromycin, which is a weaker CYP3A4 inhibitor) if possible, or reduce the fluticasone dose if systemic effects are observed.
Potential for increased systemic corticosteroid effects, particularly with high doses of fluticasone or prolonged co-administration. Effects may include adrenal suppression or hyperglycemia.
Use with caution. Monitor for signs of systemic corticosteroid effects. Consider using an alternative macrolide antibiotic (e.g., azithromycin, which is a weaker CYP3A4 inhibitor) if possible, or reduce the fluticasone dose if systemic effects are observed.
Potential for increased systemic corticosteroid effects, particularly with high doses of fluticasone or prolonged co-administration. Effects may include adrenal suppression or hyperglycemia.
Use with caution. Monitor for signs of systemic corticosteroid effects. Consider reducing the dose of fluticasone propionate if systemic effects are observed.
Increased risk of systemic corticosteroid effects, such as adrenal suppression, hyperglycemia, and Cushingoid features, especially with prolonged use or high doses of fluticasone.
Use with caution. Monitor patients for signs of systemic corticosteroid effects. Consider reducing the dose of fluticasone propionate or using an alternative antifungal if prolonged co-administration is necessary.
Increased risk of systemic corticosteroid effects, such as adrenal suppression, hyperglycemia, and Cushingoid features, especially with prolonged use or high doses of fluticasone.
Use with caution. Monitor patients for signs of systemic corticosteroid effects. Consider reducing the dose of fluticasone propionate or using an alternative antifungal if prolonged co-administration is necessary.
Potential for increased systemic corticosteroid effects, particularly with high doses of fluticasone or prolonged co-administration. Effects may include adrenal suppression or hyperglycemia.
Use with caution. Monitor for signs of systemic corticosteroid effects. Consider reducing the dose of fluticasone propionate if systemic effects are observed.
Slightly increased systemic exposure to fluticasone propionate. Clinical significance is generally low for inhaled/intranasal forms due to extensive first-pass metabolism and low oral bioavailability, but could be more relevant with high oral doses or in susceptible individuals.
Advise patients to avoid consuming large amounts of grapefruit juice, especially if they are on high doses of fluticasone propionate or are experiencing systemic corticosteroid effects. Generally not a major concern for typical inhaled/intranasal use.
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Sources: KD Tripathi 7e, Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team