- Corticosteroids with extremely potent vasoconstrictive and anti-inflammatory activity
- The effectiveness of inhaled fluticasone is due to its direct local effect
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%)
- 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
- May occur with wheezing after inhalation
- Stop steroid and treat with a fast-acting bronchodilator
- 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