Warning about CYP3A inhibition, Paxlovid, and Corticosteroids ⚠️

Fri, 13 Mar 2026 00:00:00 +0000

TLDR

Probably shouldn’t have taken corticosteroids and Paxlovid; it can suppress the HPA axis and may cause secondary adrenal failure or secondary Cushing’s.

A few light bulbs go off

I had a few lightbulb moments recently. One specifically was seeing a cardiologist for a POTS test (which was negative with orthostatic testing). What triggered this is I was diagnosed with metabolic syndrome by my PCP and stage II hypertension despite still exercising, eating healthy, low stress, normal weight, and sleeping as best I can (it’s okay to good most nights with medication). This metabolic syndrome diagnosis came at 14 months in of long COVID.

Cardio said I’m fine, but I need to get my blood pressure under control. Turns out it’s masked; if I take my own blood pressure at the doctor, it’s stage II; if a nurse or doctor pushes the button, it’s stage I hypertension. This is essentially the opposite of white coat syndrome and inherently more dangerous. I know I’ve had masked hypertension for a long time but was told otherwise. This has finally been charted for my doctors to ignore now going forward (yes, I’m bitter, and more on this shortly).

Cardiology and the link

A very long story short, I did labs for cardio. I told her you don’t need to; they’re going to be normal, but in the interest of pacifying both of us, I agreed. Well, they were, except for one thing still in the normal range but on the low side: cortisol. My morning fasting cortisol was just 7.1. The cardiologist said everything is in the normal range, just like ‘you’ said.

Date	Value	Normal range
Feb 3, 2026	7.1mcg/dL	2.9 - 19.4 mcg/dL
Dec 27, 2024	17.4mcg/dL	2.9 - 19.4 mcg/dL

Lab results pre and post covid.

I started researching my charts over the past 15 months. One thing that stuck out was I was taking Paxlovid while on Flovent and then prescribed prednisone for my rebound covid. That right there should have never happened, and here is why: https://pubmed.ncbi.nlm.nih.gov/18459946/

I reached out to my inhaler and Xolair prescriber, Asthma and Allergy, and they said that never should have never happened either; it would have been flagged at the pharmacy, to say the least. The problem is, he was only prescribing my inhalers; Paxlovid and prednisone came from two different urgent care doctors—however, all of these people are in the same health care network and have access to my chart.

I have been taking Symbicort throughout this. I got steroid injections in my neck for pain repeatedly last year. Furthermore, I was scheduled to get steroid injections again at the end of this month (I have since cancelled this).

Endocrinology

Likewise, I reached out to my endocrinologist (whom I haven’t seen in 18 months) and told him my cortisol number and also my suspicions of HPA-axis suppression. Needless to say, I have had an urgent ACTH stimulation test scheduled for several weeks out 🙄

I wanted to put this out there if someone is in a similar boat as me, and hopefully it can help point others in the right direction.

Next Steps