(floo tik' a sone)Â
P Â - Caution when used during pregnancy
L Â - Caution when used during lactation
|Indication & Dosage||Nasal
Treatment and prophylaxis ofÂ allergic rhinitis
Adult:Â 100 mcg into each nostril once daily, increased to 100 mcg bid.
Child:Â >4 yr: 50 mcg into each nostril once daily, increased to 50 mcg bid.
Adult:Â As propionate: 200 mcg to be instilled into each nostril 1-2 times daily for at least 4-6 wk.Â
Adult:Â As powder or aerosol: 100-250 mcg bid in mild cases, up to 500-1000 mcg bid in severe cases.Â
Child:Â As powder or aerosol: >4 yr: Initially, 50-100 mcg bid. May increase to 200 mcg, if necessary.
Adult:Â As nebuliser: 0.5-2 mg bid.Â
Child:Â As nebuliser: 4-16 yr: 1 mg bid.Â
ChronicÂ obstructive pulmonary disease
Adult:Â As powder or aerosol: 500 mcg bid.Â
Adult:Â As propionate: Apply a 0.05 or 0.005% cream/ointment onto affected area.
|Contraindications||Hypersensitivity. Acne vulgaris, rosacea, perioral dermatitis, skin atrophy; hypersensitivity. Primary cutaneous viral infections (e.g. herpes simplex, chicken pox), perianal and genital pruritus, primary fungal or bacterial skin infections. Inhalation: Status asthmaticus.|
|Special Precautions||Children, pregnancy, lactation, concomitant skin infections. Concomitant skin/lung/systemic infections. Advised to rinse mouth with water every time after inhalation. Application to large areas, broken skin or under occlusive dressings.|
|Adverse Drug Reactions||Topical: Pruritus,
hypertrichosis, dryness, numbness of fingers, burning, eruptions, hypopigmentation, allergic contact dermatitis, secondary infection, skin atrophy,
Cushing's syndrome, reversible HPA-axis suppression. Inhalation: Oropharyngeal candidiasis, pharyngitis, dysphoria, cough, rhinitis, nasal congestion and
headache. Systemic absorption may be seen when applied to large areas, when skin is broken or under occlusive dressings.
Potentially Fatal:Â Suppression of immune system.
|Drug Interactions||May lead to increased plasma concentrations of fluticasone when used with CYP4503A4 inhibitors such as ritonavir.Â Please consult detailed drug interactions before prescribing.|
|Pregnancy Category (US FDA)
||Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.|
|Storage||Inhalation:Â Store at 25Â°C.Â Nasal:Â Store at 4-30Â°C.Â Topical/Cutaneous:Â Store at 15-30 Â°C.|
||Fluticasone utilises a fluorocarbothioate ester linkage at the C17 position. It has potent
vasoconstrictive and anti-inflammatory activity, but weak HPA inhibitory effect when applied topically.
Absorption:Â Poorly absorbed from the GI tract (oral).
Distribution:Â Protein-binding: 91%.
Metabolism:Â Extensively hepatic; converted to 17Î²-carboxylic acid.
Excretion:Â Faeces (as unchanged drug and metabolites), urine (as metabolites).
|ATC Classification||R03BA05 - fluticasone; Belongs to the class of other inhalants
used in the treatment of obstructive airway diseases, glucocorticooids.Â
D07AC17 - fluticasone; Belongs to the class of potent (group III) corticosteroids. Used in the treatment of dermatological diseases.Â
R01AD08 - fluticasone; Belongs to the class of topical corticosteroids used as nasal decongestants.
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|AVAMYS||GlaxoSmithKline Bangladesh Limited||Fluticasone furoate 27.5mcg/actuation||Nasal Spray||120 doses spray unit: 300.00 MRP|
|CUTISONE||General Pharmaceuticals Ltd||Fluticasone propionate 0.05% Cream & 0.005% Ointment||Other||10gm Cream & Oint.: 96.36 & 50.19 MRP|
|CUTIVATE||GlaxoSmithKline Bangladesh Limited||Fluticasone propionate 0.05% Cream & 0.005% Ointment||Other||10gm Cream & Oint.: 115.43 & 76.14 MRP|
|FLIXONASE Aq||GlaxoSmithKline Bangladesh Limited||Fluticasone propionate BP 50mcg/actuation, 20ml||Nasal Spray||120 doses spray unit: 275.00 MRP|
|FLONASPRAY N-SPRAY||Square Pharmaceuticals Ltd.||Fluticasone Propionate 50 mcg/spray||Nasal Spray||120 sprays: 251.7 MRP|
|FLUPION||Amico Laboratories Ltd.||Fluticasone propionate 0.005% Ointment||Ointment||10gm: 50.00 MRP|
|FLUTICON||The Acme Laboratories Ltd.||Fluticasone propionate BP 50mcg/actuation, 20ml||Nasal Spray||120 doses spray unit: 250.00 MRP|
|FLUTIDERM||Drug International Ltd||Fluticasone propionate 0.005% Ointment||Ointment||10gm: 90.00 MRP|
|FLUTIVATE||R A K Pharmaceuticals Pvt. Ltd.||Fluticasone propionate 0.05% cream||Cream||10gm: 96.00 MRP|
|FLUVATE||Opsonin Pharma Limited||Fluticasone propionate BP 50mcg/actuation, 20ml||Nasal Spray||120 doses spray unit: 250.00 MRP|
|FLUVATE Ointment||Opsonin Pharma Limited||Fluticasone propionate 0.005% Ointment||Ointment||10gm: 50.00 MRP|
|LUTISONE||Incepta Pharmaceuticals Limited||Fluticasone Propionate 50 mcg/Spray||Nasal Spray||120 Metered Dose: 250.00 MRP|
|LUTISONE Ointment||Incepta Pharmaceuticals Limited||Fluticasone Propionate 0.005% Ointment||Ointment||10gm: 50.00 MRP|
|Neotison||Incepta Pharmaceuticals Limited||Fluticasone Furoate INN 27.5mcg per actuation||Nasal Spray||120 metered spray:MRP 250 Tk|
|PERINASE||Beximco Pharmaceuticals Ltd||Fluticasone Propionate 50 mcg /Actuation||Nasal Spray||120 MD: 250.00 MRP|
|TICAS 0.005%||Square Pharmaceuticals Ltd.||Fluticasone Propionate 0.005%||Ointment||10 gm: 40.27 MRP|
|TICAS 0.05%||Square Pharmaceuticals Ltd.||Fluticasone Propionate 0.05%||Cream||10 gm: 90.61 MRP|
|TICASON||Asiatic Laboratories Ltd.||Fluticasone propionate 0.05% Cream & 0.005% Ointment||Other||10gm Cream & Oint.: 90.00 & 40.00 MRP|
Why is this medication prescribed?
Fluticasone oral inhalation is used to prevent difficulty breathing, chest tightness, wheezing, and coughing caused by asthma. Fluticasone is in a class of medications called corticosteroids. It works by decreasing swelling and irritation in the airways to allow for easier breathing.
Fluticasone nasal spray is used to treat the symptoms of seasonal (occurs only at certain times of year), and perennial (occurs all year round) allergic rhinitis and perennial nonallergic rhinitis. These symptoms include sneezing and stuffy, runny, or itchy nose. Fluticasone is in a class of medications called corticosteroids. It works by preventing and decreasing inflammation (swelling that can cause other symptoms) in the nose.
Fluticasone Topical, is used to reduce inflammation and relieve itching, redness, dryness, and scaling associated with various skin conditions.
How should this medicine be used?
Fluticasone oral inhalation
Fluticasone comes as an aerosol to inhale by mouth. Fluticasone is usually inhaled twice a day. Try to use fluticasone at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor to explain any part you do not understand. Use fluticasone exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Talk to your doctor about how you should use your other oral and inhaled medications for asthma during your treatment with fluticasone inhalation. If you were taking an oral steroid such as dexamethasone (Decadron, Dexone), methyl prednisolone (Medrol), or prednisone, your doctor may want to gradually decrease your steroid dose starting at least 1 week after you begin to use fluticasone. Special care will be needed in certain situations for several months as your body adjusts to the change in medication. Ask your doctor for more information.
Fluticasone helps to prevent asthma attacks (sudden episodes of shortness of breath, wheezing, and coughing) but will not stop an asthma attack that has already started. Do not use fluticasone during an asthma attack. Your doctor will prescribe a short-acting inhaler to use during asthma attacks.
Your doctor will probably start you on an average dose of fluticasone. Your doctor may decrease your dose when your symptoms are controlled or increase it if your symptoms have not improved after at least 2 weeks.
Fluticasone controls asthma but does not cure it. Your symptoms may improve 24 hours after you begin using fluticasone, but it may take 2 weeks or longer before you feel the full benefit of the medication. Continue to use fluticasone even if you feel well. Do not stop using fluticasone without talking to your doctor.
Tell your doctor if your asthma worsens during your treatment. Call your doctor if you have an asthma attack that does not stop when you use your fast-acting asthma medication, or if you need to use more of your fast-acting medication than usual.
The inhaler that comes with fluticasone aerosol is designed for use only with a canister of fluticasone. Never use it to inhale any other medication, and never use any other inhaler to inhale fluticasone.
Each canister of fluticasone aerosol is designed to provide 60 or 120 inhalations, depending on its size. After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication. You should keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last. Throw away the canister after you have used the labeled number of inhalations even if it still contains some liquid and continues to release a spray when it is pressed. Do not float the canister in water to see if it still contains medication.
Before you use your fluticasone aerosol inhaler the first time, read the written instructions that come with it. Look at the diagrams carefully and be sure that you recognize all the parts of the inhaler. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler while he or she watches.
Do not use your fluticasone inhaler while you are near an open flame or a heat source. The inhaler may explode if it is exposed to very high temperatures.
To use the aerosol inhaler, follow these steps:Â
Before you use the inhaler for the first time, remove it from the overwrap. Throw away the overwrap and the drying packet that is inside the overwrap.
Be sure that the inhaler is at room temperature.
Remove the cap from the mouthpiece. The strap on the side of the cap will stay attached to the actuator to keep the cap from getting lost. Check the mouthpiece for dirt and other objects before each use, especially if the cap was not used to cover the mouthpiece.
Be sure the canister is fully and firmly inserted in the actuator. Shake the inhaler well for 5 seconds.
If you are using the inhaler for the first time, prime it by releasing four test sprays into the air, away from your face. Shake the inhaler for 5 seconds before each spray. If you have not used the inhaler in more than 7 days, or if you have dropped the inhaler, shake the inhaler for 5 seconds and release one spray into the air. Be careful not to spray the medication into your eyes.
Breathe out through your mouth.
Hold the inhaler facing you with the mouthpiece on the bottom. Place your thumb under the mouthpiece and your index finger on the top of the canister. Place the mouthpiece in your mouth and close your lips around it.
Breathe in deeply and slowly through your mouth. At the same time, press down firmly on the top of the canister with your index finger. Remove your index finger as soon as the spray is released.
When you have breathed in fully, remove the inhaler from your mouth and close your mouth.
Try to hold your breath for 10 seconds.
If your doctor told you to inhale more than one puff, wait 30 seconds, shake the canister again, and repeat steps 6 through 10 for each puff.
Put the cap back on the mouthpiece.
Rinse your mouth with water and spit the water out. Do not swallow the water.
Clean your inhaler once a week after an evening dose. To clean your inhaler, follow these steps:Â
Remove the mouthpiece cap, but leave the canister in the actuator.
Dampen the tip of a cotton swab with water. Use the damp swab to clean the small hole where the medication comes out. Twist the swab in a circular motion to remove any medication that is left in or near the hole.
Repeat step 2 with a second cotton swab.
Dampen a clean tissue with water. Wipe the inside of the mouthpiece with the damp tissue.
Leave the mouthpiece uncovered overnight to allow it to air dry.
- Replace the mouthpiece cap when the actuator is dry.
Fluticasone nasal spray
Fluticasone comes as a liquid to spray in the nose. It is usually sprayed in each nostril once daily or twice daily in the morning and evening. It is sometimes used only as needed to treat symptoms. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use fluticasone exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Fluticasone nasal spray is only for use in the nose. Do not swallow the nasal spray and be careful not to spray it in your eyes.
Your doctor will probably start you on a high dose of fluticasone nasal spray and may decrease your dose after your symptoms are controlled.
Fluticasone nasal spray controls the symptoms of rhinitis but does not cure the condition. Your symptoms will probably not begin to improve for at least 12 hours after you first use fluticasone, and it may take several days or longer before you feel the full benefit of fluticasone. Fluticasone works best when used regularly. Use fluticasone on a regular schedule unless your doctor has told you to use it as needed. Continue to use fluticasone even if you feel well. Do not stop using fluticasone without talking to your doctor.
Each bottle of fluticasone nasal spray is designed to provide 120 sprays. The bottle might not be empty after 120 sprays have been used, but each spray might not contain the correct amount of medication. You should keep track of the number of sprays you have used and throw away the bottle after you have used 120 sprays even if it still contains some liquid.
To use the nasal spray, follow these steps:
Shake the bottle gently.
Remove the dust cover.
If you are using the pump for the first time or have not used it for a week or more, you must prime it by following steps 4 to 5 below. If you have used the pump in the past week, skip to step 6.
Hold the pump with the applicator between your forefinger and middle finger and the bottom of the bottle resting on your thumb. Point the applicator away from your body.
If you are using the pump for the first time, press down and release the pump six times. If you have used the pump before, but not within the past week, press down and release the pump until you see a fine spray.
Blow your nose until your nostrils are clear.
Hold one nostril closed with your finger.
Tilt your head slightly forward and carefully put the nasal applicator into your other nostril. Be sure to keep the bottle upright.
Hold the pump with the applicator between your forefinger and middle finger and the bottom resting on your thumb.
Begin to breathe in through your nose.
While you are breathing in, use your forefinger and middle finger to press firmly down on the applicator and release a spray.
Breathe gently in through the nostril and breathe out through your mouth.
If your doctor told you to use two sprays in that nostril, repeat steps 6 to 12.
Repeat steps 6 to 13 in the other nostril.
Wipe the applicator with a clean tissue and cover it with the dust cover.
Fluticasone Topical comes as an ointment and cream to apply to the skin. It usually is applied two to four times a day at evenly spaced intervals. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use fluticasone exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Do not stop using fluticasone without talking to your doctor.
Thoroughly clean the affected area, allow it to dry, and then gently rub the medication in until most of it disappears. Use just enough medication to cover the affected area. You should wash your hands after applying the medication. The scalp lotion should be applied directly from the squeeze bottle to the affected area.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor for more information.
What special precautions should I follow?
Before using fluticasone oral inhalation,
- tell your doctor if you are allergic to fluticasone or any other medications.
- tell your doctorÂ what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or have recently taken. Be sure to mention any of the following: amiodarone; antifungals such as fluconazole, itraconazole, and ketoconazole; cimetidine; clarithromycin; cyclosporine; danazol; delavirdine; diltiazem; fluoxetine; fluvoxamine; HIV protease inhibitors such as indinavir, nelfinavir, ritonavir Â and saquinavir; isoniazid; metronidazole; nefazodone; hormonal contraceptives; oral steroids such as dexamethasone, methylprednisolone, and prednisone; paroxetine;troleandomycin; verapamil; and zafirlukast. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- if you are using any other inhaled medications, ask your doctor if you should inhale these medications a certain amount of time before or after you inhale fluticasone inhalation.
- tell your doctor if you have or have ever had tuberculosis (a type of infection) in your lungs, cataracts (clouding of the lens of the eye), glaucoma (an eye disease),or liver disease. Also tell your doctor if you have any type of untreated infection anywhere in your body or a herpes infection (a type of infection that causes a sore on the eyelid or eye surface) in your eye.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using fluticasone, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using fluticasone.
- you should know that your body may be less able to cope with stress such as surgery, illness, severe asthma attack, or injury. Call your doctor right away if you get sick and be sure that all healthcare providers who treat you know that you are using fluticasone.
- tell your doctor if you have never had chickenpox or measles and you have not been vaccinated against these infections. Stay away from people who are sick, especially people who have chickenpox or measles. If you are exposed to one of these infections or if you develop symptoms of one of these infections, call your doctor right away. You may need treatment to protect you from these infections.
- you should know that fluticasone inhalation sometimes causes wheezing and difficulty breathing immediately after it is inhaled. If this happens, use your fast-acting (rescue) asthma medication right away and call your doctor. Do not use fluticasone inhalation again unless your doctor tells you that you should.
What special dietary instructions should I follow?
Talk to your doctor about drinking grapefruit juice while taking this medication.
What should I do if I forget a dose?
Skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.
What side effects can this medication cause?
Fluticasone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
stuffy or runny nose
sore or irritated throat
- painful white patches in the mouth or throat
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
new or increased acne (pimples)
enlarged face and neck
growth of hair on the face
irregular menstruation (periods)
pink or purple stretch marks on the skin
swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
difficulty breathing or swallowing
chest pain or tightness
shortness of breath
red or fluid filled bumps on skin
burning, tingling, numbness, or weakness in arms or legs
Fluticasone may cause children to grow more slowly. There is not enough information to tell whether using fluticasone decreases the final height that children will reach when they stop growing. Your child's doctor will watch your child's growth carefully while your child is using fluticasone.Talk to your child's doctor about the risks of giving this medication to your child.
In rare cases, people who used fluticasone for a long time developed glaucoma or cataracts. Talk to your doctor about the risks of using fluticasone and how often you should have your eyes examined during your treatment.
Fluticasone may increase your risk of developing osteoporosis (a condition in which the bones become thin and weak and break easily). Talk to your doctor about the risks of using this medication.
Fluticasone may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
What should I know about storage and disposal of this medication?
Store your fluticasone inhaler with the mouthpiece down.Store it out of reach of children, at room temperature and away from excess heat and moisture (not in the bathroom). Do not store the inhaler near a heat source or an open flame. Protect the inhaler from freezing and direct sunlight. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. Do not puncture the aerosol container and do not throw it away in an incinerator or fire.
In case of emergency/overdose
In case of overdose,Â consult your doctor. If the victim has collapsed or is not breathing, consult local medical emergency services.
Inhaling too much fluticasone on a regular basis over a long period of time may cause the following symptoms:
enlarged face and neck
new or worsening acne
irregular menstrual periods
loss of appetite
fainting or dizziness when standing up from a sitting or lying position
darkening of skin
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to this medicine.
Do not let anyone else use your medication. If you still have symptoms and need further treatment, consult your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Ref:Â Â U.S. National Library of Medicine.
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.