Class: Inhaled Adrenal Corticosteroid
Dosage Forms. Metered Dose Inhaler: 44 mcg/actuation, 110 mcg/actuation, 220 mcg/actuation
Common FDA Label Indication, Dosing, and Titration.
1. Asthma: Children 4-11 y of age, regardless of previous treatment, starting dose 88 mcg bid with max dose of 88 mcg bid; Children 12 y of age and older and Adults: Patients previously treated with inhaled bronchodilators alone, 88 mcg bid, titrate dose to response with maximum of 440 mcg bid; Patients previously treated with inhaled corticosteroids, starting dose 88-220 mcg bid; titrate dose to response with max of 440 mcg bid; Patients previously treated with oral corticosteroids, starting dose 440 mcg bid; titrate dose to response with max of 880 mcg bid
Off-Label Uses. None
MOA. Fluticasone is a synthetic trifluorinated corticosteroid with anti-inflammatory effects. It is a human glucocorticoid receptor agonist that inhibits multiple cell types and mediator production or secretion involved in asthma. Glucocorticosteroids are naturally occurring and synthetic adrenocortical steroids, cause varied metabolic effects, modify the body’s immune responses to diverse stimuli, and are used primarily for their anti-inflammatory effects in disorders of many organ systems.
Drug Characteristics: Fluticasone Oral Inhaler
Medication Safety Issues: Fluticasone Oral Inhaler
Drug Interactions: Fluticasone Oral Inhaler
Adverse Reactions: Fluticasone Oral Inhaler
Efficacy Monitoring Parameters. Control of asthma symptoms, as measured by PFTs.
Toxicity Monitoring Parameters. While only small amounts of fluticasone reach systemic circulation, bone mineral density and growth and development in children should be monitored. Routine ophthalmologic examinations should be performed. Monitor for signs and symptoms of adrenal suppression or infection (including oral candidiasis).
Key Patient Counseling Points. Proper administration technique for these inhaled products. Instruct on rinsing mouth with water after each use to prevent oral infections. Monitor for signs of toxicity, especially adrenal insufficiency, oral candidiasis, and worsening pulmonary function.
Clinical Pearls. Flovent Diskus product also available for the treatment of asthma; delivers fluticasone in powder form with dosing similar to the metered dose inhaler formulation. Intranasal and topical dosage forms of fluticasone also available for treatment of other allergic disorders.