Fluticasone

• Fluticasone

• Flovent®

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

• Asthma
• COPD

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]

• Mild asthma: 100-250 mcg twice daily

• Moderate asthma: 250-500 mcg twice daily

• Highest recommended dose: 440 mcg twice daily

• 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

• 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%)

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

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