Fluticasone

Fluticasone Brand Names

ARMONAIR RESPICLICK | ARNUITY ELLIPTA | ClariSpray | Cutivate | Flonase | Flonase Allergy Relief | Flonase Sensimist | Flovent | Flovent Diskus | Flovent HFA | Flovent Rotadisk | Veramyst | XHANCE

What is Fluticasone

Fluticasone is a synthetic fluorinated corticosteroid administered topically, intranasally and via oral inhalation; many products are available for use in adults and pediatric patients.

Topical products are of medium-potency and are used to relieve the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses and psoriasis.

Nasal formulations are effective for symptoms of non-allergic rhinitis, as well as seasonal and perennial allergic rhinitis and related symptoms of allergic conjunctivitis. Nasal dosage forms are also effective at reducing nasal polyps.

Fluticasone oral inhalation products are used for the maintenance treatment of asthma or chronic obstructive pulmonary disease (COPD). Orally inhaled corticosteroids (ICS) are considered a preferred pharmacologic treatment in the long-term management of persistent asthma of various severities according to the Expert Panel of the National Asthma Education and Prevention Program (NAEPP).

The NAEPP concluded that ICSs are the most potent and consistently effective class of medications for the long-term control of asthma in both adults and children.

Superior efficacy of ICSs has been demonstrated over other long-term control medications including leukotriene receptor antagonists, cromolyn, and theophylline.

Additionally, fluticasone may be used for prevention of exercise-induced bronchoconstriction (EIB) as a controller agent added to an inhaled short-acting beta-2 agonist (SABA) to control EIB symptoms in patients who cannot be controlled by an inhaled SABA alone.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD, fluticasone may be used in combination with an inhaled long-acting beta-2 agonist (LABA) as initial therapy in group D (those with a high risk of exacerbation).

Combination of a LABA with an ICS has the greatest likelihood of reducing exacerbations in patients with blood eosinophil counts of 200 cells/microL and higher.

An ICS combined with a LABA is more effective than the individual components in improving lung function and health status and reducing exacerbations in patients with exacerbations and moderate to very severe COPD; however clinical trials failed to demonstrate a statistically significant effect on survival.

Fluticasone was first approved by the FDA in 1990.

Indications

1. allergic conjunctivitis
2. allergic rhinitis
3. alopecia
4. asthma
5. atopic dermatitis
6. chronic bronchitis
7. chronic obstructive pulmonary disease (COPD)
8. contact dermatitis
9. discoid lupus erythematosus
10. eczema
11. emphysema
12. exercise-induced bronchospasm prophylaxis
13. exfoliative dermatitis
14. lichen planus
15. lichen simplex
16. lichen striatus
17. nasal polyps
18. pemphigus
19. perennial allergies
20. polymorphous light eruption
21. pompholyx
22. prurigo
23. pruritus
24. psoriasis
25. Rhus dermatitis
26. seasonal allergies
27. seborrheic dermatitis
28. vasomotor rhinitis
29. xerosis

Side Effects

1. abdominal pain
2. acne vulgaris
3. acneiform rash
4. adrenocortical insufficiency
5. agitation
6. anaphylactoid reactions
7. angioedema
8. anosmia
9. anxiety
10. arthralgia
11. back pain
12. bleeding
13. blurred vision
14. bronchospasm
15. candidiasis
16. cataracts
17. cholecystitis
18. Churg-Strauss syndrome
19. colitis
20. conjunctivitis
21. contact dermatitis
22. cough
23. Cushing’s syndrome
24. dental caries
25. dental pain
26. depression
27. diarrhea
28. dizziness
29. dysmenorrhea
30. dyspepsia
31. dysphonia
32. dyspnea
33. ecchymosis
34. elevated hepatic enzymes
35. eosinophilia
36. epistaxis
37. erythema
38. fatigue
39. fever
40. flushing
41. folliculitis
42. glycosuria
43. growth inhibition
44. headache
45. hematoma
46. hoarseness
47. hyperglycemia
48. hypertrichosis
49. hypotension
50. hypothalamic-pituitary-adrenal (HPA) suppression
51. immunosuppression
52. impaired wound healing
53. increased intracranial pressure
54. infection
55. influenza
56. insomnia
57. irritability
58. keratitis
59. laryngitis
60. leukopenia
61. malaise
62. menstrual irregularity
63. migraine
64. miliaria
65. muscle cramps
66. muscle paralysis
67. musculoskeletal pain
68. nasal congestion
69. nasal dryness
70. nasal irritation
71. nasal septum perforation
72. nausea
73. ocular hypertension
74. ocular irritation
75. oral ulceration
76. osteopenia
77. osteoporosis
78. otalgia
79. palpitations
80. pharyngitis
81. pruritus
82. purpura
83. rash
84. restlessness
85. rhinalgia
86. rhinitis
87. rhinorrhea
88. sinusitis
89. skin atrophy
90. skin hypopigmentation
91. skin irritation
92. skin ulcer
93. sneezing
94. striae
95. telangiectasia
96. throat irritation
97. thrombocytopenia
98. tolerance
99. tooth discoloration
100. urticaria
101. vaginitis
102. vasculitis
103. vesicular rash
104. visual impairment
105. vomiting
106. weight gain
107. wheezing
108. withdrawal
109. xerophthalmia
110. xerosis
111. xerostomia

Monitoring Parameters

• blood glucose
• growth rate
• pulmonary function tests (PFTs)
• serum potassium
• weight

Contraindications

• acne rosacea
• acne vulgaris
• acute bronchospasm
• breast-feeding
• cataracts
• children
• corticosteroid hypersensitivity
• Cushing’s syndrome
• diabetes mellitus
• formaldehyde hypersensitivity
• fungal infection
• geriatric
• glaucoma
• growth inhibition
• hepatic disease
• herpes infection
• hypothalamic-pituitary-adrenal (HPA) suppression
• increased intracranial pressure
• increased intraocular pressure
• infants
• infection
• malnutrition
• measles
• milk protein hypersensitivity
• nasal septal perforation
• nasal surgery
• nasal trauma
• occlusive dressing
• ocular exposure
• osteoporosis
• perioral dermatitis
• peripheral vascular disease
• pregnancy
• skin abrasion
• skin atrophy
• status asthmaticus
• sunlight (UV) exposure
• surgery
• tobacco smoking
• tuberculosis
• varicella
• viral infection

Interactions

• Abatacept
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetazolamide
• Acetohexamide
• Adalimumab
• Albiglutide
• Aldesleukin, IL-2
• Alemtuzumab
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alogliptin; Metformin
• Alpha-glucosidase Inhibitors
• Altretamine
• Ambenonium Chloride
• Amifampridine
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminolevulinic Acid
• Aminosalicylate sodium, Aminosalicylic acid
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphotericin B
• Amphotericin B cholesteryl sulfate complex (ABCD)
• Amphotericin B lipid complex (ABLC)
• Amphotericin B liposomal (LAmB)
• Antithymocyte Globulin
• Antitumor antibiotics
• Argatroban
• Arsenic Trioxide
• Asparaginase Erwinia chrysanthemi
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atazanavir
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Atracurium
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azathioprine
• Azilsartan; Chlorthalidone
• Basiliximab
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Bepridil
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bivalirudin
• Bortezomib
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Phenylephrine
• Bupropion
• Bupropion; Naltrexone
• Butabarbital
• Calcium Carbonate
• Calcium Carbonate; Magnesium Hydroxide
• Calcium Carbonate; Risedronate
• Calcium Carbonate; Simethicone
• Canagliflozin
• Canagliflozin; Metformin
• Candesartan; Hydrochlorothiazide, HCTZ
• Captopril; Hydrochlorothiazide, HCTZ
• Carbamazepine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Phenylephrine
• Carmustine, BCNU
• Ceritinib
• Chlophedianol; Guaifenesin; Phenylephrine
• Chlorambucil
• Chloramphenicol
• Chlorothiazide
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Phenylephrine
• Chlorpropamide
• Chlorthalidone
• Chlorthalidone; Clonidine
• Choline Salicylate; Magnesium Salicylate
• Cimetidine
• Cisatracurium
• Citalopram
• Clarithromycin
• Clindamycin
• Clofarabine
• Cobicistat
• Codeine; Phenylephrine; Promethazine
• Conivaptan
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Deferasirox
• Delavirdine
• Denileukin Diftitox
• Denosumab
• Desmopressin
• Dextran
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Digoxin
• Dipeptidyl Peptidase-4 Inhibitors
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
• Dofetilide
• Doxacurium
• Droperidol
• Dulaglutide
• Echinacea
• Econazole
• Efalizumab
• Elbasvir; Grazoprevir
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enalapril; Hydrochlorothiazide, HCTZ
• Ephedrine
• Eprosartan; Hydrochlorothiazide, HCTZ
• Ertugliflozin
• Ertugliflozin; Metformin
• Ertugliflozin; Sitagliptin
• Estramustine
• Estrogens
• Exenatide
• Fluconazole
• Fluoxymesterone
• Fosamprenavir
• Fosinopril; Hydrochlorothiazide, HCTZ
• Gallium Ga 68 Dotatate
• Gemcitabine
• Gentamicin
• Glimepiride
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glipizide
• Glipizide; Metformin
• Glyburide
• Glyburide; Metformin
• Glycerol Phenylbutyrate
• grapefruit juice
• Guaifenesin; Phenylephrine
• Halofantrine
• Haloperidol
• Hemin
• Heparin
• Hetastarch
• Hydantoins
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Phenylephrine
• Hydroxyurea
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibritumomab Tiuxetan
• Idelalisib
• Incretin Mimetics
• Indapamide
• Indinavir
• Inebilizumab
• Insulin Degludec; Liraglutide
• Insulin Glargine; Lixisenatide
• Insulins
• Interferon Alfa-2a
• Interferon Alfa-2b
• Interferon Alfa-2b; Ribavirin
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Isoproterenol
• Isotretinoin
• Itraconazole
• Ketoconazole
• L-Asparaginase Escherichia coli
• Letermovir
• Levetiracetam
• Levomethadyl
• Linagliptin; Metformin
• Liraglutide
• Lixisenatide
• Lomustine, CCNU
• Loop diuretics
• Lopinavir; Ritonavir
• Macimorelin
• Magnesium Salicylate
• Mannitol
• Mecasermin rinfabate
• Mecasermin, Recombinant, rh-IGF-1
• Meglitinides
• Melphalan
• Mepenzolate
• Mephobarbital
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methacholine
• Methazolamide
• Methenamine; Sodium Acid Phosphate
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methoxsalen
• Methyclothiazide
• Metolazone
• Metyrapone
• Micafungin
• Mifepristone
• Mitotane
• Mitoxantrone
• Mivacurium
• Moxifloxacin
• Muromonab-CD3
• Natalizumab
• Nateglinide
• Nefazodone
• Nelarabine
• Nelfinavir
• Neostigmine
• Neuromuscular blockers
• Nicardipine
• Nonsteroidal antiinflammatory drugs
• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole; Amoxicillin; Rifabutin
• Ondansetron
• Oxymetholone
• Pancuronium
• Pegaspargase
• Penicillamine
• Phenobarbital
• Phenylephrine
• Phenylephrine; Promethazine
• Photosensitizing agents (topical)
• Physostigmine
• Pimozide
• Posaconazole
• Potassium
• Potassium Chloride
• Potassium Phosphate; Sodium Phosphate
• Potassium-sparing diuretics
• Pramlintide
• Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
• Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
• Primidone
• Propranolol
• Purine analogs
• Pyridostigmine
• Quetiapine
• Rapacuronium
• Regular Insulin
• Repaglinide
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rifamycins
• Rifapentine
• Ritodrine
• Ritonavir
• Rituximab
• Rituximab; Hyaluronidase
• Rocuronium
• Salicylates
• Salsalate
• Saquinavir
• Sargramostim, GM-CSF
• Semaglutide
• SGLT2 Inhibitors
• Sodium Benzoate; Sodium Phenylacetate
• Sodium Chloride
• Sodium Phenylbutyrate
• Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
• Somatropin, rh-GH
• Succinylcholine
• Sulfonylureas
• Telaprevir
• Telbivudine
• Telithromycin
• Telotristat Ethyl
• Testosterone
• Thiazide diuretics
• Thiazolidinediones
• Thyroid hormones
• Tipranavir
• Tobramycin
• Tolazamide
• Tolbutamide
• Tositumomab
• Tranexamic Acid
• Tretinoin, ATRA
• Tuberculin Purified Protein Derivative, PPD
• Tubocurarine
• Tucatinib
• Vancomycin
• Vecuronium
• Vigabatrin
• Vincristine Liposomal
• Voriconazole
• Vorinostat
• Warfarin
• Zafirlukast