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
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  • 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
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