Fluticasone

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Dosage 4 Pharmacokinetics 5 Adverse-effects 6 Drug-interactions 7 Test-interactions 8 More General Terms 9 Internet Database 10 References

Introduction

• Tradenames: Flonase (fluticasone propionate), Veramyst (fluticasone furoate) - intranasal, Flovent, Flovent Diskus, Flovent Rotadisk ( inhaler) Cutivate (topical)

Indications

• seasonal & perennial allergic rhinitis in adults & children > 4 years of age
• asthma prophylaxis
• NOT indicated for treatment of acute bronchial asthma

Dosage

• nasal spray:

• 2 sprays QD
• 0.05%, 50 ug/actuation, 16 g = 120 actuations.

• inhaler:

• 2 puffs BID,
• 110 & 220 ug/actuation, 13 g = 120 actuations
• 90% of maximum benefit at 250 ug/day
• no increased benefit of doses > 500 ug/day [5]

• topical: 0.05% ointment/cream BID/ TID

Pharmacokinetics

• metabolized by CYP3A4
  

• elimination via liver

Adverse-effects

• oral inhalation

• common (> 10%)

• headache, respiratory tract infection, pharyngitis, nasal congestion

• less common (1-10%)

• oral candidiasis ( thrush), dysphonia, sinusitis

• uncommon (< 1%)

• hypothalamic- pituitary axis suppression, Cushing's syndrome, growth retardation, burning, irritation, secondary infection nasal administration

• not common (1-10%)

• epistaxis, nasal burning, headache
  
• drug adverse effects of glucocorticoids
• drug adverse effects of immunosuppressive agents

Drug-interactions

• clarithromycin may increase systemic levels of fluticasone [8]
  
• drug interaction(s) of glucocorticoids with warfarin

Test-interactions

• metered dose inhaler use may reduce morning cortisol [6]

More General Terms

• glucocorticoid
• antiasthmatic agent

Internet Database

PubChem: 54580
PubChem: 62924
PubChem: 5311101
PubChem: 3399
PubChem: 444036

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 743
4. Prescriber's Letter 8(2):supplement 2001
5. Journal Watch 21(19):153, 2001 Holt et al, BMJ 323:253, 2001
6. Journal Watch 22(5):41, 2002 Eid et al, Pediatrics 109:217, 2002
7. Prescriber's Letter 14(6): 2007 New Nasal Steroids: Veramyst and Omnaris Detail-Document#: [1] (subscription needed) [2]
8. Prescriber's Letter 17(7): 2010 Clarithromycin Interaction with Salmeterol and Inhaled Corticosteroids Detail-Document#: [3] (subscription needed) [4]

fluticasone (Flonase, Veramyst, Flovent, Cutivate)