Formulary
Fluticasone: Indications, Dosing, Side Effects and Interactions
Fluticasone clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 8 min read
Fluticasone: Indications, Dosing, Side Effects and Interactions
Fluticasone clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Prophylaxis of asthma**
- **Child** (By Inhalation Of Powder): 16-17 years Initially 100-500 micrograms twice daily, increased if necessary up to 1 mg twice daily, doses above 500 micrograms twice daily to be initiated by a specialist, dose to be adjusted as necessary.
- **Adult** (By Inhalation Of Powder): Initially 100-500 micrograms twice daily, increased if necessary up to 1 mg twice daily, doses above 500 micrograms twice daily to be initiated by a specialist, dose to be adjusted as necessary.
- **Child** (By Inhalation Of Aerosol): 16-17 years Initially 100-500 micrograms twice daily, increased if necessary up to 1 mg twice daily, doses above 500 micrograms twice daily to be initiated by a specialist, dose to be adjusted as necessary.
- **Adult** (By Inhalation Of Aerosol): Initially 100-500 micrograms twice daily, increased if necessary up to 1 mg twice daily, doses above 500 micrograms twice daily to be initiated by a specialist, dose to be adjusted as necessary.
- **Child** (By Inhalation Of Nebulised Suspension): 16-17 years 0.5-2 mg twice daily.
- **Adult** (By Inhalation Of Nebulised Suspension): 0.5-2 mg twice daily.
**Severe inflammatory skin disorders such as dermatitis and eczemas unresponsive to less potent corticosteroids,Psoriasis**
- **Child** (To The Skin): 3 months-17 years Apply 1-2 times a day, to be applied thinly.
- **Adult** (To The Skin): Apply 1-2 times a day, to be applied thinly.
**Prophylaxis of asthma for fluticasone**
- **Child 5-15 years** (By inhalation of powder): Initially 50-100 micrograms twice daily, increased if necessary up to 200 micrograms twice daily, dose to be adjusted as necessary.
- **Child 16-17 years** (By inhalation of powder): Initially 100-500 micrograms twice daily, increased if necessary up to 1 mg twice daily, doses above 500 micrograms twice daily to be initiated by a specialist, dose to be adjusted as necessary.
- **Child 4-15 years** (By inhalation of aerosol): Initially 50-100 micrograms twice daily, increased if necessary up to 200 micrograms twice daily, dose to be adjusted as necessary.
- **Child 16-17 years** (By inhalation of aerosol): Initially 100-500 micrograms twice daily, increased if necessary up to 1 mg twice daily, doses above 500 micrograms twice daily to be initiated by a specialist, dose to be adjusted as necessary.
- **Child 4-15 years** (By inhalation of nebulised suspension): 1 mg twice daily.
- **Child 16-17 years** (By inhalation of nebulised suspension): 0.5-2 mg twice daily.
**Prophylaxis and treatment of allergic rhinitis and perennial rhinitis for fluticasone**
- **Child 4-11 years** (By intranasal administration using nasal spray): 50 micrograms once daily, dose to be administered into each nostril preferably in the morning, increased if necessary to 50 micrograms twice daily, dose to be administered into each nostril.
- **Child 12-17 years** (By intranasal administration using nasal spray): 100 micrograms once daily, dose to be administered into each nostril preferably in the morning, increased if necessary to 100 micrograms twice daily, dose to be administered into each nostril; reduced to 50 micrograms once daily, dose to be administered into each nostril, dose to be reduced when control achieved.
**Nasal polyps for fluticasone**
- **Child 16-17 years** (By intranasal administration using nasal drops): 200 micrograms 1-2 times a day, dose to be administered into each nostril (200 micrograms is equivalent to approximately 6 drops), alternative treatment should be considered if no improvement after 4-6 weeks.
**Severe inflammatory skin disorders such as dermatitis and eczemas unresponsive to less potent corticosteroids, Psoriasis for fluticasone**
- **Child 1-2 months** (To the skin): Apply 1-2 times a day, to be applied thinly.
- **Child 3 months-17 years** (To the skin): Apply 1-2 times a day, to be applied thinly.
**Prophylaxis and treatment of allergic rhinitis for Avamys spray**
- **Child 6-11 years** (By intranasal administration): 27.5 micrograms once daily, dose to be sprayed into each nostril, then increased if necessary to 55 micrograms once daily, dose to be sprayed into each nostril, reduced to 27.5 micrograms once daily, dose to be sprayed into each nostril, dose to be reduced once control achieved; use minimum effective dose.
- **Child 12-17 years** (By intranasal administration): 55 micrograms once daily, dose to be sprayed into each nostril, reduced to 27.5 micrograms once daily, dose to be sprayed into each nostril, dose to be reduced once control achieved; use minimum effective dose.
Cautions
For all corticosteroids (intranasal) Avoid after nasal surgery (until healing has occurred); avoid in pulmonary tuberculosis; avoid in the presence of untreated nasal infections; patients transferred from systemic corticosteroids may experience exacerbation of some symptoms Cautions, further information Systemic absorption Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; therefore also consider the cautions and side-effects of systemic corticosteroids. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. Cautions For all corticosteroids (topical) Avoid prolonged use (particularly on the face); cautions applicable to systemic corticosteroids may also apply if absorption occurs following topical and local use; dermatoses of infancy, including nappy rash (extreme caution required-treatment should be limited to 5-7 days) (in children); infection; keep away from eyes; use potent or very potent topical corticosteroids under specialist supervision (in children); use potent or very potent topical corticosteroids under specialist supervision in psoriasis (can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity) (in adults)
Contraindications
For all corticosteroids (topical) Acne; perioral dermatitis; potent corticosteroids in widespread plaque psoriasis; rosacea; untreated bacterial, fungal or viral skin lesions
Side effects
For all corticosteroids (inhaled) Common or very common Headache; oral candidiasis; pneumonia (in patients with COPD); taste altered; voice alteration Uncommon Bronchospasm paradoxical; cataract; vision blurred Rare or very rare Adrenal suppression; anxiety; behaviour abnormal; glaucoma; growth retardation (in children); sleep disorder Side-effects, further information Systemic absorption may follow inhaled administration particularly if high doses are used or if treatment is prolonged. Therefore also consider the side-effects of systemic corticosteroids. Candidiasis The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water after inhalation of a dose may also be helpful. An anti-fungal oral suspension or oral gel can be used to treat oral candidiasis without discontinuing corticosteroid therapy. Paradoxical bronchospasm The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind. Mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation). Side-effects For all corticosteroids (intranasal) Common or very common Altered smell sensation; epistaxis; headache; nasal complaints; taste altered; throat irritation Rare or very rare Glaucoma; nasal septum perforation (more common following nasal surgery); vision blurred Side-effects, further information Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged. Therefore also consider the side-effects of systemic corticosteroids. Side-effects For all corticosteroids (topical) Common or very common Skin reactions; telangiectasia Rare or very rare Adrenal suppression; hypertrichosis; skin depigmentation (may be reversible) Frequency not known Local reaction; vasodilation Side-effects, further information Side-effects applicable to systemic corticosteroids may also apply if absorption occurs following topical and local use. In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective. Side-effects For fluticasone Rare or very rare When used by inhalation Dyspepsia Frequency not known With intranasal use Adrenal suppression Side-effects, further information Nasal ulceration occurs commonly with nasal preparations containing fluticasone furoate.
Interactions
**Severe interactions:**
- Hence, clinically significant drug interactions mediated by fluticasone propionate are unlikely.
- During postmarketing use, there have been reports of clinically significant drug interactions in patients receiving intranasal or inhaled fluticasone propionate and ritonavir, resulting in systemic...
- CORTICOSTEROIDS Corticosteroids primarily metabolised by CYP3A (including betamethasone, budesonide, fluticasone, mometasone, prednisone, triamcinolone) Fluticasone: in a clinical study where...
- Based on drug interaction studies conducted with Biktarvy or the components of Biktarvy, no clinically significant drug interactions are expected with: amlodipine, atorvastatin, buprenorphine,...
**Other interactions (12):**
- GLUCOCORTICOIDS Corticosteroids Corticosteroids primarily metabolised by CYP3A (including betamethasone, budesonide, fluticasone, mometasone, prednisone, triamcinolone).
- Concomitant use of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Gilead and corticosteroids that are metabolised by CYP3A (e.g.
- Inhaled, injectable or intranasal fluticasone propionate, budesonide, triamcinolone Fluticasone propionate, 50 g intranasal 4 times daily: Plasma concentrations Cortisol levels 86% Greater...
- Systemic corticosteroid effects including Cushing's syndrome and adrenal suppression have been reported in patients receiving ritonavir and inhaled or intranasally administered fluticasone...
- Fluticasone propionate Under normal circumstances, low plasma concentrations of fluticasone propionate are achieved after intranasal dosing, due to extensive first pass metabolism and high systemic...
- A drug interaction study in healthy subjects has shown that ritonavir (a highly potent cytochrome P450 3A4 inhibitor) can greatly increase fluticasone propionate plasma concentrations, resulting in...
Pregnancy
For all corticosteroids (inhaled) Inhaled drugs for asthma can be taken as normal during pregnancy.
Breast feeding
For all corticosteroids (inhaled) Inhaled corticosteroids for asthma can be taken as normal during breast-feeding.
Medicinal forms
Powder,Drops,Spray,Cream,Ointment
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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