fluticasone (Flonase, Veramyst, Flovent, Arnuity Ellipta)
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Introduction
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)
- cutaneous T-cell lymphoma[9]
Contraindications
Dosage
- nasal spray:
- 2 sprays QD
- 0.05%, 50 ug/actuation, 16 g = 120 actuations.
- hydrofluoroalkane inhaler:
- Arnuity Ellipta: 100 or 200 mg QD (dry powder inhaler)
- topical: 0.05% ointment/cream BID/TID
Pharmacokinetics
elimination via liver
Adverse effects
oral inhalation
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- hypothalamic-pituitary axis suppression, Cushing's syndrome, growth retardation, burning, irritation, secondary infection
nasal administration
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]
- drug interaction(s) of fluticasone with HIV1 protease inhibitors
- drug interaction(s) of methotrexate with biological response modifier
- drug interaction(s) of glucocorticoids with warfarin
- drug interaction(s) of NSAIDs with glucocorticoid
Test interactions
- metered dose inhaler use may reduce morning cortisol[6]
Laboratory
More general terms
More specific terms
Component of
- calcitriol/fluticasone/tacrolimus
- all trans retinoic acid/fluticasone/hydroquinone
- azelastine/fluticasone
- fluticasone/salmeterol (Advair/Seretide Diskus, Wixela, AirDuo Respiclick)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 743
- ↑ Prescriber's Letter 8(2):supplement 2001
- ↑ 5.0 5.1 Journal Watch 21(19):153, 2001 Holt et al, BMJ 323:253, 2001
- ↑ 6.0 6.1 Journal Watch 22(5):41, 2002 Eid et al, Pediatrics 109:217, 2002
- ↑ Prescriber's Letter 14(6): 2007 New Nasal Steroids: Veramyst and Omnaris Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230610&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 Prescriber's Letter 17(7): 2010 Clarithromycin Interaction with Salmeterol and Inhaled Corticosteroids Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260701&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 9.0 9.1 9.2 Deprecated Reference
- ↑ 10.0 10.1 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: https://www.ncbi.nlm.nih.gov/pubmed/18459946 Free article
- ↑ 11.0 11.1 11.2 NEJM Knowledge+ Complex Medical Care
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=54580
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=62924
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5311101
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3399
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=444036