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Dependency of Cortisol Suppression on the Administration Time of Inhaled Corticosteroids
Author(s) -
Meibohm Bernd,
Hochhaus Günther,
Rohatagi Shashank,
Möllmann Helmut,
Barth Jürgen,
Wagner Melanie,
Krieg Michael,
Stöckmann Ricarda,
Derendorf Hartmut
Publication year - 1997
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1002/j.1552-4604.1997.tb04357.x
Subject(s) - fluticasone propionate , medicine , fluticasone , pharmacokinetics , pharmacodynamics , morning , pharmacology , corticosteroid
Endogenous cortisol suppression is one of the major systemic side effects of inhaled corticosteroids in the treatment of asthma. A previously developed pharmacokinetic/pharmacodynamic approach was used to evaluate the influence of administration time on the cumulative cortisol suppression (CCS) after single doses of the inhaled corticosteroids flunisolide and fluticasone propionate. Administration time‐dependent simulations of CCS were performed with drug‐specific pharmacokinetic and pharmacodynamic parameters obtained from previous clinical trials. Both drugs showed similar diurnal variation in CCS, dependent on the administration time, with maximum suppression when administered in the early morning at approximately 3 am . The optimum administration time for minimized CCS was in the afternoon but was shifted from 3 pm for fluticasone propionate to later time points around 7 pm for flunisolide, probably because of the shorter terminal elimination half‐life of flunisolide. Regarding peak to trough fluctuation, however, CCS after fluticasone propionate showed only half the administration time dependency as after flunisolide. Therefore, the ratio between CCS after flunisolide and after fluticasone propionate also followed administration time‐dependent variations. This led to the conclusion that administration time has to be considered as a pivotal influential factor in clinical studies comparing CCS among different inhaled corticosteroids.