Fluticasone

Generic name

  • Fluticasone

Brand names

  • Flovent®

Drug class

  • Corticosteroids with extremely potent vasoconstrictive and anti-inflammatory activity
  • The effectiveness of inhaled fluticasone is due to its direct local effect 

Indications

  • Asthma
  • COPD

Preparations

Aerosol, for oral inhalation, as propionate:

  • Flovent® HFA: 44 mcg/inhalation (10.6 g); 110 mcg/inhalation (12 g); 220 mcg/inhalation (12 g) [chlorofluorocarbon free; 120 metered actuations]

Powder, for oral inhalation, as propionate:

  • Flovent® Diskus®: 50 mcg (60s); 100 mcg (60s); 250 mcg (60s) [contains lactose]

Dosing

  • Mild asthma: 100-250 mcg twice daily

  • Moderate asthma: 250-500 mcg twice daily

  • Highest recommended dose: 440 mcg twice daily

Drug Interactions

  • Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Amphotericin B
  • Corticosteroids (Orally Inhaled) may diminish the hypoglycemic effect of Antidiabetic Agents
  • Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Loop Diuretics.
  • Immunosuppressants may diminish the therapeutic effect of BCG
  • May decrease the metabolism of CYP3A4 Substrates
  • Telaprevir may increase the serum concentration of Corticosteroids

Adverse effects

  • Headache (2% to 14%)
  • Throat irritation (3% to 22%)
  • Upper respiratory tract infection (14% to 21%)
  • Fever (1% to 7%)
  • Oral candidiasis (≤9%)
  • Nnausea/vomiting (1% to 8%)
  • Gastrointestinal infection (including viral; 1% to 5%)
  • Gastrointestinal discomfort/pain (1% to 4%)
  • Musculoskeletal pain (2% to 5%)
  • Muscle injury (1% to 5%)
  • Sinusitis/sinus infection (4% to 10%)
  • Lower respiratory tract infections/pneumonia (1% to 7%; COPD diagnosis and age >65 years increase risk)
  • Cough (1% to 6%)
  • Bronchitis (≤8%)
  • Hoarseness/dysphonia (2% to 6%)
  • Uupper respiratory tract inflammation (≤5%)
  • Viral respiratory infection (1% to 5%)
  • Rhinitis (1% to 4%)

Warning

Hepatic Impairment:

  • Fluticasone is primarily cleared in the liver.
  • Fluticasone plasma levels may be increased in patients with hepatic impairment, use with caution; monitor.
  • Adrenal suppression:
    • May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods.
    • HPA axis suppression may lead to adrenal crisis.
    • Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully
    • Also seizure has been reported in adrenal crisis
  • Bronchospasm:
    • May occur with wheezing after inhalation
    • Stop steroid and treat with a fast-acting bronchodilator
  • Immunosuppression:
    • Prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines.
  • Psychiatric disturbances:
    • Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes.
    • Pre-existing psychiatric conditions may be exacerbated by corticosteroid use
  • Cardiovascular disease:
    • long-term use in heart failure patients has been associated with fluid retention and hypertension.
  • Gastrointestinal disease:
    • In patients with GI diseases  such as diverticulitis, peptic ulcer, ulcerative colitis may increase the perforation risk.
  • Ocular disease: Use with caution in patients with cataracts and/or glaucoma

Pregnancy & Lactation

  • Inhaled corticosteroids are recommended for the treatment of asthma (most information available using budesonide) during pregnancy.
  • Excretion in breast milk unknown/use caution
error: Content is protected !!