Fluticasone

Mechanism :

Fluticasone propionate is a synthetic trifluorinated corticosteroid with potent anti-inflammatory activity. It is as potent as Budesonide and requires only half the dose as Budesonide.

Indication :

Asthma
Allergic rhinitis
Nasal polyp

Contraindications :

It is contraindicated in the primary treatment of status asthmaticus or other acute episodes of asthma or COPD where intensive measures are required. Hypersensitivity to any of the ingredients of these preparations contraindicates their use.

Dosing :

Asthma Maintenance: Inhalation powder.

Under 4 years:

Safety and efficacy not established

4 to 11 years:

Initial dose: 50 mcg twice daily; maximum dose: 100 mcg twice daily.

12 years or older:

Initial dose: 100 mcg twice daily; maximum dose: 500 mcg twice daily.

Acute exacerbation of asthma:

Nebulized 1 mg 2 times daily.

Allergic rhinitis:

Nasal spray.

4-12 years:

50 mcg (1 spray) in each nostril. Max: 100 mcg in each nostril twice daily.

Adverse Effect :

Adrenal suppression, posterior subcapsular cataracts on prolonged use. Oral candidiasis, hoarseness of voice, throat irritation.

Interaction :

Paradoxical bronchoconstriction: Should be treated immediately with a fast-acting inhaled bronchodilator.
Ritonavir: There have been reports of clinically significant drug interactions in patients receiving fluticasone propionate and ritonavir, resulting in systemic corticosteroid effects including Cushing syndrome and adrenal suppression. Therefore, co administration of fluticasone propionate and ritonavir is not recommended unless the potential benefit to the patient outweighs the risk of systemic corticosteroid side effects.
Ketoconazole: Caution should be exercised when fluticasone propionate Nasal Spray is coadministered with ketoconazole and other known potent cytochrome P450 3A4 inhibitors.

Hepatic Dose :

Oral formulation: Fluticasone is primarily eliminated in the liver and serum concentrations may be elevated in patients with hepatic impairment. Use with caution and closely monitor.
Topical formulation: No dosage adjustments are recommended.
Nasal formulation: No dosage adjustments are recommended. Use with caution in patients with severe hepatic impairment as systemic availability of fluticasone may be increased in patients with hepatic impairment.