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fluticasone (Flonase, Veramyst, Flovent, Arnuity Ellipta)

Tradenames: Flonase (fluticasone propionate), Veramyst (fluticasone furoate) - intranasal, Flovent, Flovent Diskus, Flovent Rotadisk (inhaler) Indications: - seasonal & perennial allergic rhinitis in adults & children > 4 years of age - asthma prophylaxis - COPD - relief of inflammatory dermatoses (dermatitis) - allergic dermatitis - atopic dermatitis, contact dermatitis [9] - seborrheic dermatitis - rash - discoid lupus - granuloma annulare - psoriasis - pruritus, anal pruritus - lichen simplex chronicus - cutaneous T-cell lymphoma [9] Contraindications: - treatment of acute bronchial asthma Dosage: 1) nasal spray: a) 2 sprays QD b) 0.05%, 50 ug/actuation, 16 g = 120 actuations. 2) hydrofluoroalkane inhaler: a) 2 puffs BID, b) 110 & 220 ug/actuation, 13 g = 120 actuations c) 90% of maximum benefit at 250 ug/day d) no increased benefit of doses > 500 ug/day [5] 3) Arnuity Ellipta: 100 or 200 mg QD (dry powder inhaler) 4) topical: 0.05% ointment/cream BID/TID Pharmacokinetics: - metabolized by CYP3A4 Adverse effects: oral inhalation 1) common (> 10%) - headache, respiratory tract infection, pharyngitis, nasal congestion 2) less common (1-10%) - oral candidiasis (thrush), dysphonia, sinusitis 3) 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 interactions: - clarithromycin, ritonavir & other strong inhibitors of CYP3A4 may increase systemic levels of fluticasone* [8] - in patients taking strong inhibitors of CYP3A4, abrupt withdrawal of glucocorticoids metabolized by cyt-P450 3A4 including inhaled glucocorticoids fluticasone & budesonide can result in adrenal insufficiency - no abdominal hyperpigmentation [11] * if ritonavir is required, use low-dose budesonide or beclomethasone [10,11] Test interactions: -> metered dose inhaler use may reduce morning cortisol [6] Laboratory: - fluticasone in serum/plasma - fluticasone in urine

Interactions

drug interactions drug adverse effects (more general classes) monitor with drug (more general classes)

Specific

Fluticasone Nasal; EDS-FLU (Xhance) Fluticasone Topical (Cutivate)

General

antiasthmatic agent glucocorticoid

Properties

MISC-INFO: elimination route LIVER pregnancy-category C safety in lactation - ?

Database Correlations

PUBCHEM correlations

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#: 230610 (subscription needed) http://www.prescribersletter.com
  8. Prescriber's Letter 17(7): 2010 Clarithromycin Interaction with Salmeterol and Inhaled Corticosteroids Detail-Document#: 260701 (subscription needed) http://www.prescribersletter.com
  9. Deprecated Reference
  10. Foisy MM, Yakiwchuk EM, Chiu I, Singh AE. Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature. HIV Med. 2008 Jul;9(6):389-96. PMID: 18459946 Free article
  11. NEJM Knowledge+ Complex Medical Care

Component-of

all trans retinoic acid/fluticasone/hydroquinone azelastine/fluticasone calcitriol/fluticasone/tacrolimus fluticasone/salmeterol (Advair/Seretide Diskus, Wixela, AirDuo Respiclick)