There are also many drug interactions . Patients must read in detail the enclosed data sheet(s) of the medicine. For example, the azole antifungals such as ketoconazole or itraconazole can be both substrates and inhibitors of the P-glycoprotein , which (among other functions) excretes toxins and drugs into the intestines.  Azole antifungals also are both substrates and inhibitors of the cytochrome P450 family CYP3A4 ,  causing increased concentration when administering, for example, calcium channel blockers , immunosuppressants , chemotherapeutic drugs , benzodiazepines , tricyclic antidepressants , macrolides and SSRIs .
The effect of CLOBEX® Spray, % on hypothalamic-pituitary-adrenal (HPA) axis function was investigated in adults in two studies. In the first study, patients with plaque psoriasis covering at least 20% of there body applied CLOBEX® Spray, % twice daily for up to 4 weeks. 15% (2 out of 13) of patients displayed adrenal suppression after 4 weeks of use based on the Cosyntropin Stimulation Test. The laboratory suppression was transient; all subjects returned to normal after cessation of drug use. In the second study, patients with plaque psoriasis covering at least 20% of their body applied CLOBEX® Spray, % twice daily for either 2 or 4 weeks. 19% (4 out of 21) of patients treated for 2 weeks and 20% (3 out of 15) of patients treated for 4 weeks displayed adrenal suppression at the end of treatment based on the Cosyntropin Stimulation Test. The laboratory suppression was transient; all subjects returned to normal after cessation of drug use. In these studies, HPA axis suppression was defined as serum cortisol level ≤ 18 μg/dL 30-min post cosyntropin (ACTH 1-24) stimulation [see WARNINGS AND PRECAUTIONS ].