BMA Concise Guide to Medicine & Drugs

Fluticasone

Brand names Cutivate, Flixonase, Flixotide, Nasofan

Used in the following combined preparations Flutiform, Relvar, Seretide

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Drug group Corticosteroid

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes (except for nasal spray)

Available as generic No

GENERAL INFORMATION

Fluticasone is a corticosteroid drug used to control inflammation in asthma and allergic rhinitis. It does not produce relief immediately, so it is important to take it regularly. For allergic rhinitis, treatment with the nasal spray needs to begin two to three weeks before the hay fever season commences. Fluticasone should be taken regularly by inhaler to prevent asthma attacks; proper instruction is essential to ensure correct use. Fluticasone is also prescribed in the form of an ointment or cream to treat dermatitis and eczema (see Topical corticosteroids).

Fluticasone has few serious adverse effects because it is administered directly into the lungs (by inhaler) or nasal mucosa (by nasal spray). Fungal infection causing irritation of the mouth and throat is a possible side effect of the inhaled form but can be minimized by thoroughly rinsing the mouth and gargling with water after each inhalation.

INFORMATION FOR USERS

Follow instructions on the label. Call your doctor if symptoms worsen.

How taken/used Ointment, cream, inhaler, nasal spray.

Frequency and timing of doses Allergic rhinitis 1–2 x daily; asthma 2 x daily

Adult dosage range Allergic rhinitis 1–2 sprays into each nostril per dose; asthma 100–1,000mcg per dose.

Onset of effect 4–7 days (asthma); 3–4 days (allergic rhinitis).

Duration of action The effects can last for several days after stopping the drug.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. Adverse effects may occur if the recommended dose is regularly exceeded over a prolonged period.

POSSIBLE ADVERSE EFFECTS

The main adverse effects of the nasal spray are irritation of the nasal passages and nosebleeds. The principal side effects of the inhaler are coughing and fungal infection of the throat and mouth, which may cause hoarseness and soreness. The risk of developing a fungal infection can be minimized by thoroughly rinsing the mouth, gargling with water, or brushing the teeth after every inhalation. The cream and ointment do not usually produce adverse effects with short-term use. Long-term use of any form of fluticasone may result in various other adverse effects (see Prolonged use).

INTERACTIONS

Ritonavir, telaprevir, and iraconazole may increase the blood level of fluticasone and the risk of adrenal gland suppression.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have chronic sinusitis.

· You have had recent nasal ulcers or nasal surgery.

· You have had tuberculosis or another respiratory infection.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding Safety in breast-feeding not established. Drug unlikely to pass into breast milk; discuss with doctor.

Infants and children Not recommended under 4 years. Reduced dose necessary in older children. Avoid prolonged use of ointment in children.

Over 60 No known problems.

Driving and hazardous work No known problems.

Alcohol No known problems.

PROLONGED USE

Long-term use of topical and inhaled fluticasone can lead to peptic ulcers, muscle weakness, osteoporosis, growth retardation in children, and, rarely, adrenal gland suppression. Rarely, nasal spray may cause glaucoma. Prolonged use of topical treatment may also lead to skin thinning. Patients on long-term fluticasone should carry a steroid card or wear a MedicAlert bracelet.

Monitoring Periodic checks on adrenal gland function may be required if large doses are being taken. Children should have their height monitored.