fluticasone propionate oral inhaler (Flovent)

Fluticasone propionate is a man-made steroid of the glucocorticoid family which is related to the naturally-occurring steroid hormone, cortisol or hydrocortisone, produced by the adrenal glands. Glucocorticoid steroids have potent anti-inflammatory actions. When used as an inhaler, fluticasone travels to the airways in the lung. In asthmatic patients, the suppression of inflammation within the airways reduces the spasm of muscle cells that surround the airways as well as the accumulation of fluid and cells that accompanies the inflammation which lead to narrowing of the airways. The narrowing makes it difficult to get air into and out of the lungs. When used in lower doses, very little fluticasone is absorbed into the body. When higher doses are used, fluticasone is absorbed and may cause side effects elsewhere in the body. The FDA approved fluticasone in March 1996.

Flovent Diskus, Flovent HFA

GENERIC AVAILABLE: No

Yes

The most common side effects of fluticasone are:

• headache,
• upper respiratory infections,
• throat irritation,
• nasal congestion,
• nasal discharge, and
• hoarseness or difficulty speaking.

Fluticasone may also cause bronchospasms (wheezing). Bronchospasms should be treated with a rescue inhaler.

Oral candidiasis or thrush (a fungal infection) may occur.

High doses of inhaled fluticasone may decrease formation and increase break-down of bone thereby weakening bones and promoting fractures.

Higher doses of fluticasone also may suppress the body's ability to make its own natural glucocorticoid in the adrenal gland. People with suppression of their adrenal glands (which can be diagnosed by a testing performed by doctors) need increased amounts of glucocorticoids, probably by the oral or intravenous route, during periods of high physical stress when glucocorticoids are particularly important.

Inhaled steroids may suppress growth, weaken the immune system, and may increase the risk of glaucoma (increased eye pressure), and cataracts.

Doses vary from patient to patient.

The recommended dose for the aerosol is 88 to 440 mcg twice daily.

The recommended dose for the Diskhaler is 100 to 1000 mcg twice daily. Following administration, the mouth should be rinsed thoroughly with water or mouthwash to minimize dry mouth, irritation of the throat, and hoarseness.

The aerosol inhaler must be cleaned at least once a week.

If a bronchodilator aerosol spray (a spray that causes the airways to expand), for example, albuterol (Proventil; Ventolin), is used, it should be used first, and then 5-15 minutes later fluticasone should be used.

Ritonavir (Norvir), atazanavir (Reyataz), clarithromycin (Biaxin), indinavir (Crixivan), itraconazole (Sporanox), ketoconazole, nelfinavir (Viracept), and telithromycin (Ketek) may increase levels of fluticasone in the body by reducing the breakdown of fluticasone by liver enzymes. This may increase side effects of fluticasone.

Adequate studies of fluticasone during pregnancy have not been done. Fluticasone use during pregnancy should be avoided unless the potential benefit justifies the potential but unknown risk to the fetus.

It is not known if fluticasone is secreted in breast milk. Other medications in the same class as fluticasone are secreted into breast milk. It is not known whether the small amounts that may appear in the milk affect the infant.

What preparations of fluticasone propionate oral inhaler are available?

Inhalation aerosol: 44, 110, and 220 mcg/inhalation. Inhalation Powder (Diskhaler): 50, 100, and 250 mcg/inhalation

How should I keep fluticasone propionate oral inhaler stored?

Fluticasone should be kept at room temperature, 4 C - 30 C (39 F - 86 F), and the aerosol should be shaken well before each use.

Other important side effects include Allergic reactions such as:

• including swelling of face,
• throat swelling,
• tongue swellling,
• rash,
• hives, and
• breathing problems