D01AC20 - Imidazoles/Triazoles in Combination with Corticosteroids

Possibly porphyrinogenic

Rationale

One component (Miconazole) is possibly a CYP-inducer as well as inhibitor of several CYPs. Warned against in two references. Hydrocortisone: Glucocorticoid. Substrate for CYPs 3A4, 3A7, 11 B2. Inducer and inhibitor of CYP 3A4. Several references stating non-porphyrinogenicity. The combination is reported to be tolerated in 2 patients; in 1 patient it is suspected to have caused porphyric symptoms.

Chemical description

Antimycotic combined with mild glucocorticoid used in mycoses with inflammatory engagement. No data on the extent of absorbtion but should not be more pronounced than for miconazole alone, i.e. insignificant. Miconazole: broadspectrum imidazole antimycotic creme for dermatological use in thin application. Only slightly absorbed. Inhibitor of CYPs 11B1, 19 (aromatase), 1A2, 2A6, 2B6 (potent), c19 (potent), 2D6 (potent), 3A4 (potent) and 51. Hydrocortisone: weak glucocorticoid.

Personal communication

Miconazole: Thunell, patient report (n=1): tolerated. Andersson C, patient reports: tolerated (n=2; possible adverse reaction (n=1)).

IPNet drug reports

Uneventful use reported in 1 patient with acute porphyria.

Similar drugs

Explore alternative drugs in similar therapeutic classes D01A / D01AC or go back.

References

#	Citation details	PubMed ID
1.	Management of acute attacks in the porphyrias. Kalman DR, Bonkovsky HL. Clin Dermatol. 1998; 16(2):299-306.	9554242
2.	Drugs in the acute porphyrias--toxicogenetic diseases. Moore MR, Hift RJ. Cell Mol Biol (Noisy-le-grand). 1997 Feb; 43(1):89-94.	9074793
Porphyria Drug Lists
3.	French List Centre Français des Porphyries
4.	South African List Porphyria South Africa No longer maintained
Other sources
5.	Porphyrin metabolism and the Porphyrias [Book Chapter] Tschudy DP, Lamon JM Bondy BK, Rosenberg LE (eds): Duncan's Diseases of Metabolism, Philadelphia, WB Saunders. 1980.