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

Contraindications

pregnancy category = c

safety in lactation = -

safety in lactation = ?

Dosage

  • nasal spray:
    • 2 sprays QD
    • 0.05%, 50 ug/actuation, 16 g = 120 actuations.
  • hydrofluoroalkane inhaler:
    • 2 puffs BID,
    • 110 & 220 ug/actuation, 13 g = 120 actuations
    • 90% of maximum benefit at 250 ug/day
    • no increased benefit of doses > 500 ug/day[5]
  • 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

nasal administration

Drug interactions

* if ritonavir is required, use low-dose budesonide or beclomethasone[10][11]

Test interactions

Laboratory

More general terms

More specific terms

Component of

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. 5.0 5.1 Journal Watch 21(19):153, 2001 Holt et al, BMJ 323:253, 2001
  6. 6.0 6.1 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#: 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. 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. 9.0 9.1 9.2 Deprecated Reference
  10. 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. 11.0 11.1 11.2 NEJM Knowledge+ Complex Medical Care

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