Which medications are known to decrease glucocorticoid metabolism?

The correct answer identifies medications that are known to inhibit glucocorticoid metabolism, thereby increasing the levels and effects of glucocorticoids in the body.

Ketoconazole is a well-known antifungal agent that functions as an inhibitor of steroidogenesis. It particularly affects the enzymes responsible for cortisol synthesis and metabolism. This capacity allows it to increase glucocorticoid levels effectively, which is useful in certain pathological conditions.

Oral contraceptives can also decrease the metabolism of glucocorticoids. This occurs because the estrogen component in many oral contraceptives induces changes in liver enzyme activity, particularly those involving cytochrome P450 enzymes, which are important in the metabolic breakdown of steroids.

Macrolides, particularly erythromycin, has been shown to inhibit CYP3A4, an enzyme involved in the metabolism of various drugs, including glucocorticoids. This inhibition can lead to increased levels of glucocorticoids when used concurrently.

This combination of drugs—ketoconazole, oral contraceptives, and macrolides—creates a scenario in which glucocorticoid metabolism is significantly reduced, enhancing their pharmacological effects or duration of action. Understanding these interactions is crucial in clinical practice to avoid