Drug Detail:Fluticasone (systemic, oral inhalation) (monograph) (Flovent hfa)
Drug Class:
Usual Adult Dose for Asthma - Maintenance
Initial dose of inhaled corticosteroid (ICS) should be based upon previous therapy and asthma severity; consideration should be given to current control of asthma symptoms and risk of future exacerbations:
Fluticasone propionate INHALATION AEROSOL (Flovent HFA[R]):
Patients new to ICS: Initial dose: 88 mcg via oral inhalation twice a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose
Fluticasone propionate INHALATION POWDER (Flovent Diskus[R]):
Patients new to ICS: Initial dose: 100 mcg via oral inhalation twice a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose
Fluticasone propionate INHALATION POWDER (Armonair Respiclick[R]): One oral inhalation twice a day
- Initial dose for patients new to ICS: 55 mcg (low dose) via oral inhalation twice a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose of 113 mcg (medium dose) or 232 mcg (high dose) via oral inhalation twice a day
Fluticasone furoate INHALATION POWDER Arnuity Ellipta[R]):
Patients new to ICS: Initial dose: 100 mcg via oral inhalation once a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose
Comments:
- Higher initial doses may be considered in patients with poor asthma control or those who have previously required higher doses of other ICS.
- Inhaled short-acting beta(2)-agonists should be used for immediate relief if symptoms arise between doses.
- Maximum benefit of ICS may not be achieved for up to 2 weeks or longer; if adequate control is not achieved in 2 weeks, may increase dose without exceeding maximum dose.
- After asthma stability has been achieved, titrate to the lowest effective dose to reduce the possibility of side effects.
- Not indicated for the relief of acute bronchospasm.
Use: For the maintenance treatment of asthma as prophylactic therapy.
Usual Pediatric Dose for Asthma - Maintenance
Initial dose should be based upon previous therapy and asthma severity; consideration should be given to current control of asthma symptoms and risk of future exacerbations:
4 to 11 years:
Fluticasone propionate INHALATION POWDER (Flovent Diskus[R]):
Patients new to ICS: Initial dose: 50 mcg via oral inhalation twice a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose
Fluticasone propionate INHALATION AEROSOL (Flovent HFA[R]):
88 mcg via oral inhalation twice a day
Maximum dose: 88 mcg twice a day
12 years or older:
Fluticasone propionate INHALATION AEROSOL (Flovent HFA[R]):
Patients new to ICS: Initial dose: 88 mcg via oral inhalation twice a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose
Fluticasone propionate INHALATION POWDER (Flovent Diskus[R]):
Patients new to ICS: Initial dose: 100 mcg via oral inhalation twice a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose
Fluticasone propionate INHALATION POWDER (Armonair Respiclick[R]): One oral inhalation twice a day
- Initial dose for patients new to ICS: 55 mcg (low dose) via oral inhalation twice a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose of 113 mcg (medium dose) or 232 mcg (high dose) via oral inhalation twice a day
Fluticasone furoate INHALATION POWDER Arnuity Ellipta[R]):
Patients new to ICS: Initial dose: 100 mcg via oral inhalation once a day
- Patients previously receiving ICS as well as patients who have not adequately responded after 2 weeks may be titrated to a higher dose
Comments:
- Higher initial doses may be considered in patients with poor asthma control or those who have previously required higher doses of other ICS.
- Inhaled short-acting beta(2)-agonists should be used for immediate relief if symptoms arise between doses.
- Maximum benefit of ICS may not be achieved for up to 2 weeks or longer; if adequate control is not achieved in 2 weeks, may increase dose without exceeding maximum dose.
- After asthma stability has been achieved, titrate to the lowest effective dose to reduce the possibility of side effects.
- Not indicated for the relief of acute bronchospasm.
Use: For the maintenance treatment of asthma as prophylactic therapy.
Renal Dose Adjustments
No adjustment recommended
Liver Dose Adjustments
Use with caution; monitor for signs of systemic corticosteroid effects
Dose Adjustments
Abrupt discontinuation after prolonged use is not recommended
Inhalation doses should be reduced to the lowest effective dose once asthma stability has been achieved.
Concomitant use with strong CYP450 3A4 inhibitors is not recommended
Oral Corticosteroids:
- Patients should be weaned slowly from systemic corticosteroid use upon transfer to inhaled corticosteroids.
- Prednisone should be generally reduced in increments not exceeding 2.5 mg to 5 mg per day on a weekly basis
- Monitor for signs of asthma instability including serial objective measure of airflow
- Monitor for signs of adrenal insufficiency
Precautions
Safety and efficacy of fluticasone propionate (Flovent Diskus[R]; Flovent HFA[R]) have not been established in patients younger than 4 years.
Safety and efficacy of fluticasone propionate (Armonair Respiclick[R]) have not been established in patients younger than 12 years.
Safety and efficacy of fluticasone furoate (Arnuity Ellipta[R]) have not been established in patients younger than 12 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- For oral inhalation only
- Twice a day: Take approximately 12 hours apart
- Once a day: Take at approximately the same time each day
- Following inhalation, patients should rinse mouth with water (without swallowing) to help reduce the risk of oropharyngeal candidiasis
- Patients should receive instruction on proper use; children may need assistance to ensure proper use (Flovent HFA[R]: A valved holding chamber and mask may be used in younger patients)
Storage requirements:
INHALATION AEROSOL (Flovent HFA[R]):
- Store with mouthpiece down. Contents under pressure; do not puncture or store near heat or open flame; discard when counter reads "000" even though the canister will not be completely empty
- Prior to use: Store unopened in foil pouch in a dry place away from direct heat or sunlight
- In use: Open foil pouch only when ready to use; discard 30 days (Armonair Respiclick[R]), 6 weeks (Flovent Diskus[R] 50 mcg; Arnuity Ellipta[R] 100 and 200 mcg), or 2 months (Flovent Diskus[R] 100 and 250 mcg), after opening foil pouch or when counter reads "0"; whichever comes first.
Preparation techniques: Manufacturer product information should be consulted for more complete instructions including pictures.
- Fluticasone propionate: INHALATION AEROSOL (Flovent HFA[R]): Shake well (at least 5 seconds) before EACH spray; prime inhaler with 4 sprays before first use; prime inhaler with 1 spray when not used for 7 days (or longer) or when inhaler has been dropped; metal canister should fit firmly in the plastic actuator; to dose, breathe in deeply and slowly, hold breath for 10 seconds, then breathe out fully; do not take inhaler apart, keep protective cap on mouthpiece when not in use; clean inhaler at least 1 time each week.
- Fluticasone propionate INHALATION POWDER (Flovent Diskus[R]): Always use in a level, flat position; make sure lever firmly clicks into place; to dose, hold breath for about 10 seconds after inhaling, then breathe out fully; do not take an extra dose, even if you did not taste or feel powder; do not take inhaler apart; do not wash inhaler; do not use with a spacer device.
- Fluticasone propionate INHALATION POWDER (Armonair Respiclick[R]): Priming is not necessary; do not use with spacer or volume holding chamber; wait to open cover until ready to take dose as each time cover is opened, a dose is prepared (repeatedly opening and closing cap without inhaling a dose will waste medicine and may damage inhaler); hold breath for about 10 seconds or as long as comfortable after inhaling dose and then breathe out; close green cap after each inhalation; mouthpiece may be cleaned with a dry tissue although routine cleaning is not necessary; do not wash or put any part of inhaler in water, replace inhaler if washed or placed in water.
- Fluticasone furoate INHALATION POWDER (Arnuity Ellipta[R]): Slide cover down to expose mouthpiece; wait to open cover until ready to dose as each time cover is opened, a dose is prepared (if dose is not taken, it will no longer be available to be inhaled); hold breath about 3 to 4 seconds or as long as comfortable after inhaling dose and then breathe out slowly; mouthpiece may be cleaned with a dry tissue although routine cleaning is not necessary.
General:
- This drug is not intended for relief of acute bronchospasm.
- Onset and degree of symptom relief varies between individuals; maximum benefit may not be achieved for up to 2 weeks or longer; if adequate asthma control is not achieved in a timely manner, additional therapeutic options should be explored including increasing dose (without exceeding maximum dose) or initiation of a combination long-acting beta(2) agonist-inhaled corticosteroid.
- Patients switching or tapering off oral corticosteroid treatment, especially those receiving prednisone 20 mg/day or greater (or equivalent), are at risk of adrenal insufficiency when exposed to stress such as trauma, surgery, or infection; oral corticosteroid supplementation will be needed during periods of stress.
Monitoring:
- Monitor asthma control, including serial objective measures of airflow
- Monitor bone mineral content in patients at high risk of decreased bone mineral density
- Monitor growth regularly in pediatric patients
- Regular eye examinations should be considered, especially in patients with a history of ocular changes or those experiencing visual changes
- Periodically assess oral cavity for signs and symptoms of Candida albicans infection
- Monitor for signs and symptoms of adrenal insufficiency
- Monitor adrenocortical function in patients transferring from corticosteroids with higher systemic effects.
Patient advice:
- Patients should understand that this drug is a corticosteroid; they should know the signs and symptoms of hypercorticism, adrenal suppression, and understand that during times of stress, such as surgery or infection, additional oral corticosteroid supplementation may be necessary; they should discuss with their healthcare professional whether they need to carry a medical identification card identifying their corticosteroid use.
- Patients on immunosuppressant doses of corticosteroids should understand that a greater risk of infection exists; they should avoid exposure to chickenpox or measles and if exposed, they should consult their healthcare professional promptly.
- Patients should check with their healthcare provider before taking any new medications, including herbal supplements and over the counter products.
- Patients should be instructed on proper inhaler technique and the importance of regular use.
- Patients should be instructed to rinse and spit after oral inhalation use to avoid infection; if infection develops, they should not stop therapy, but contact their healthcare professional for guidance.
- Patients should understand this drug is not intended to relieve acute asthma symptoms and a short acting bronchodilator should be used for that; if asthma symptoms do not respond to a short acting bronchodilator, or require higher or more frequent dosing, they should contact their healthcare professional for reevaluation of therapy.
Frequently asked questions
- What are the risks of using Flonase long-term?
- How often can you use Flonase nasal spray?
- How long does it take for Flonase to work?
- Can I use fluticasone nasal spray to relieve stuffy nose due to a cold?
- What's the difference between Xhance and Flonase Allergy Relief?
