about Fluticasone class, uses, side effects contraindications
Fluticasone
Short Description
Fluticasone is a corticosteroid medication that works by blocking the release of certain natural substances that cause symptoms of inflammation, itching, swelling and redness.
Category
Chemical class: Trifluorinated corticosteroid
Therapeutic class: Antiasthmatic, antiinflammatory
Pregnancy category: C
Indications
To prevent asthma attacks, alone or with oral corticosteroids INHALATION AEROSOL Adults and children age 12 and over using bronchodilator therapy.Initial: 88 mcg inhaled b.i.d. Maximum: 440 mcg inhaled b.i.d. Adults and children age 12 and over switching from another inhaled corticosteroid.Initial: 88 to 220 mcg inhaled b.i.d. Maximum: 440 mcg inhaled b.i.d. Adults and children age 12 and over using oral corticosteroid therapy. Initial and maximum: 880 mcg inhaled b.i.d. Children ages 4 to 11 regardless of previous therapy. 88 mcg b.i.d. Maximum: 88 mcg b.i.d. To prevent seasonal or perennial allergic rhinitis NASAL SUSPENSION (FLONASE) Adults and children age 12 and over. Initial: 100 mcg (2 sprays) in each nostril daily or 50 mcg (1 spray) in each nostril b.i.d, as needed. Maintenance: 50 mcg (1 spray) in each nostril daily, as tolerated and needed. Maximum: 200 mcg daily (4 sprays). Children ages 4 to 11. 50 or 100 mcg (1 or 2 sprays) in each nostril daily in the morning, as needed. Maximum: 200 mcg daily (4 sprays). To treat seasonal or perennial allergic rhinitis NASAL SUSPENSION (FLONASE) Adults and children age 12 and over. Initial: 100 mcg (2 sprays) in each nostril daily or 50 mcg (1 spray) in each nostril b.i.d, as needed. Maintenance: 50 mcg (1 spray) in each nostril daily, as tolerated and needed. Maximum: 200 mcg daily (4 sprays). Children ages 4 to 11. 50 or 100 mcg (1 or 2 sprays) in each nostril daily in the morning, as needed. Maximum: 200 mcg daily (4 sprays). NASAL SUSPENSION(VERAMYST) Adults and children age 12 and over. fluticasone 455 E F Initial: 110 mcg (2 sprays) in each nostril once daily, decreasedto 55 mcg (1 spray) in each nostril once daily when symptoms are controlled. Maintenance: 55 mcg (1 spray) in each nostril once daily. Children ages 2 to 11. Initial: 55 mcg (1 spray) in each nostril once daily, increased to 110 mcg (2 sprays) in each nostril once daily, as needed. Maintenance: 55 mcg (1 spray) in each nostril once daily. Route Onset Peak Duration InhalaIn 24 hr 1–2 wk Several tion days Nasal 12 hr– 4–7 1–2 wk 3 days days
Mechanism of Action
Inhibits cells involved in the inflammatory response of asthma, such as mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils. Fluticasone also inhibits production or secretion of chemical mediators, such as histamine, eicosanoids, leukotrienes, and cytokines.
Contraindications
Hypersensitivity to fluticasone or its components, primary treatment of status asthmaticus or other acute asthma episodes that require intensive measures, untreated nasal mucosal infection (nasal suspension)
Interactions
ketoconazole, ritonavir and other strong cytochrome P-450 3A4 inhibitors (long-term use): Possibly increased fluticasone level and decreased serum cortisol level
Side Efect
CNS: Aggressiveness, agitation, depression, difficulty speaking, dizziness, fatigue, fever, headache, insomnia, malaise, restlessness
EENT: Allergic rhinitis, cataracts, conjunctivitis, dry mouth and throat, eye irritation, glaucoma, hoarseness, laryngitis, loss of voice, nasal congestion or discharge, nasal sinus pain, oropharyngeal candidiasis, otitis media, pharyngitis, sinusitis, throat irritation, tonsillitis
ENDO: Adrenal insufficiency, cushingoid symptoms, hyperglycemia, slower growth in children
GI: Abdominal pain, diarrhea, indigestion, nausea, vomiting
GU: Dysmenorrhea
HEME: Churg-Strauss syndrome, easy bruising, eosinophilia
MS: Arthralgia, myalgia, osteoporosis
RESP: Asthma exacerbation, bronchitis, bronchospasm, chest congestion and tightness, cough, dyspnea, pneumonia, upper respiratory tract infection, wheezing
SKIN: Dermatitis, ecchymosis, pruritus, rash, urticaria
Other: Anaphylaxis, angioedema, flulike symptoms, weight gain
Cautions
Use fluticasone cautiously in patients with ocular herpes simplex, pulmonary tuberculosis, or untreated systemic bacterial, fungal, parasitic, or viral infection. Although anaphylaxis is rare, monitor patient closely at start of therapy, especially if patient has severe allergy to milk. If hypersensitivity reaction occurs, notify prescriber, expect drug to be discontinued, and provide supportive care, as prescribed. If patient takes a systemic corticosteroid, expect to taper dosage by no more than 2.5 mg daily at weekly intervals, starting 1 week after fluticasone therapy begins.
WARNING If patient is switched from systemic corticosteroid to fluticasone, assess for adrenal insufficiency (fatigue, hypotension, lassitude, nausea, vomiting, weakness) early in therapy and when patient has infection, stress, trauma, surgery, or other electrolyte-depleting conditions or procedures. Notify prescriber immediately if signs or symptoms develop. As prescribed, administer a fast-acting inhaled bronchodilator if bronchospasm occurs immediately after fluticasone use. Expect to stop fluticasone and start another drug therapy. Expect to titrate fluticasone to lowest effective dosage after asthma has stabilized. PATIENT SAFTY
Urge patient to use fluticasone regularly, as prescribed, not for acute bronchospasm. Teach patient how to administer drug according to the form prescribed (nasal spray or oral inhaler). Instruct patient to shake canister and use inhaler according to package instructions. On first use, advise her to spray 4 times fluticasone 456 into the air (away from her eyes and shaking inhaler between each test spray) and look for a fine mist. If inhaler hasn’t been used for more than 7 days or it’s dropped, it will need to be primed again by shaking well and then releasing 1 test spray into the air (away from her face). If 2 inhalations are prescribed, tell patient to wait at least 1 minute between them. Instruct patient to gargle and rinse her mouth after each dose to help prevent dry mouth and throat, relieve throat irritation, and prevent oropharyngeal yeast infection. If patient uses more than 1 inhaler, instruct her to use fluticasone last, at least 5 minutes after previous inhaler. Instruct patient to clean inhaler according to manufacturer guidelines at least once a week after her evening dose. Inform patient that, when counter reads 020, she should obtain a refill, if needed. When counter reaches 000, she should discard the inhaler. Instruct patient using
NASAL SPRAY to shake container well before each use. Explain that symptoms may improve within 2 days but that full improvement may not occur for 1 to 2 weeks or longer. Caution patient not to increase dosage but to contact prescriber after 1 week if symptoms continue or worsen. Urge patient to tell prescriber immediately if asthma attacks don’t respond to bronchodilators during fluticasone therapy. If patient is switching from an oral corticosteroid to fluticasone, urge her to carry medical identification indicating the need for supplemental systemic corticosteroids during stress or severe asthma attack. Caution patient to avoid people who have infections because fluticasone suppresses the immune system, increasing the risk of infection. Instruct patient to notify prescriber about exposure to chickenpox, measles, or other infections because additional treatment may be needed.
Trade Name & Company Name
| Trade name | Company name |
| CUTIVATE 0.05% CREAM | GLAXO |
| FLIXOTIDE 250MCG INHALER | GLAXO |
| FLIXOTIDE 25MCG INHALER | GLAXO |
| FLIXOTIDE DISKUS 100MCG BLISTER POWDER | GLAXO |
| FLIXOTIDE DISKUS 250MCG BLISTER POWDER | GLAXO |
| FLIXOTIDE DISKUS 500MCG BLISTER POWDER | GLAXO |
| FLIXOTIDE DISKUS 50MCG BLISTER POWDER | GLAXO |
| AVAMYS SUSPENSION FOR NASAL SPRAY | GLAXOSMITHKLINE (GSK) |
effect of Fluticasone in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. There are no adequate reports or well-controlled studies of fluticasone in pregnant women. Fluticasone is a popular agent in women with asthma and commonly encountered during pregnancy. Case series are reassuring. It is not effective for the treatment of Pregnancy
rhinitis. Once-daily budesonide nasal spray, fluticasone nasal spray, mometasone furoate nasal spray, and triamcinolone aqueous nasal spray have similar efficacy and safety profiles for treatment of allergic rhinitis in adults. Differences in sensory attributes, experience during pregnancy, and cost may contribute to better patient acceptance of one versus another. A recent meta-analysis concluded that inhaled or nasal corticosteroids do not increase the rates of adverse obstetric outcomes. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. It is unknown whether fluticasone crosses the human placenta. However, inhaled or nasal corticosteroids alone do not adversely affect fetal growth or placental function. While systemically administered corticosteroids, including fluticasone, are teratogenic in some rodents and a weak effect in humans cannot be excluded, the concentration of drug absorbed suggests the risk of an adverse fetal effect is low. There are no documented epidemiologic studies with IN corticosteroids during pregnancy; however, inhaled corticosteroids have not been incriminated as teratogens and are commonly used by pregnant 418 women who have asthma. Less than 0.1% of an inhaled dose crosses the rodent placenta. Breastfeeding
There are no adequate reports or well-controlled studies in nursing women. It is unknown whether fluticasone enters human breast milk. Measurable but small amounts enter rat breast milk. However, considering the concentration and quantity absorbed systemically, it is unlikely the plasma level achieved will be clinically relevant to lactation.
the follwing drugs will increse Fluticasone by inhepiting cyp450
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the follwing drugs will decrease Fluticasone by inhancing cyp450
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trad drugs based on Fluticasone
| Gen name | Trade name | Catagory name |
| azelastine / fluticasone | Dymista | Nasal antihistamines and decongestants |
| azelastine / fluticasone | Dymista | Nasal steroids |
| fluticasone | ArmonAir Digihaler | Inhaled corticosteroids |
| fluticasone | ArmonAir RespiClick | Inhaled corticosteroids |
| fluticasone | Arnuity Ellipta | Inhaled corticosteroids |
| fluticasone | Beser | Topical steroids |
| fluticasone | Cutivate | Topical steroids |
| fluticasone | Flonase | Nasal steroids |
| fluticasone | Flonase Allergy Relief | Nasal steroids |
| fluticasone | Flonase Sensimist | Nasal steroids |
| fluticasone | Flovent | Inhaled corticosteroids |
| fluticasone | Flovent Diskus | Inhaled corticosteroids |
| fluticasone | Flovent HFA | Inhaled corticosteroids |
| fluticasone | Flovent Rotadisk | Inhaled corticosteroids |
| fluticasone | Ticanase | Nasal steroids |
| fluticasone | Veramyst | Nasal steroids |
| fluticasone | Xhance | Nasal steroids |
| fluticasone / salmeterol | Advair Diskus | Bronchodilator combinations |
| fluticasone / salmeterol | Advair HFA | Bronchodilator combinations |
| fluticasone / salmeterol | AirDuo Digihaler | Bronchodilator combinations |
| fluticasone / salmeterol | AirDuo Respiclick | Bronchodilator combinations |
| fluticasone / salmeterol | Wixela Inhub | Bronchodilator combinations |
| fluticasone / umeclidinium / vilanterol | Trelegy Ellipta | Bronchodilator combinations |
| fluticasone / vilanterol | Breo Ellipta | Bronchodilator combinations |
| Fluticasone | AVAMYS SUSPENSION FOR NASAL SPRAY | |
| Fluticasone | CUTIVATE 0.05% CREAM | |
| Fluticasone | FLIXOTIDE 250MCG INHALER | |
| Fluticasone | FLIXOTIDE 25MCG INHALER | |
| Fluticasone | FLIXOTIDE DISKUS 100MCG BLISTER POWDER | |
| Fluticasone | FLIXOTIDE DISKUS 250MCG BLISTER POWDER | |
| Fluticasone | FLIXOTIDE DISKUS 500MCG BLISTER POWDER | |
| Fluticasone | FLIXOTIDE DISKUS 50MCG BLISTER POWDER | |
other drugs from same cataogory