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fluticasone (Inhalation route)

Pronunciation

floo-TIK-a-sone

Commonly used brand name(s)

In the U.S.

  • Flovent
  • Flovent Diskus
  • Flovent HFA
  • Flovent Rotadisk

Available Dosage Forms:

  • Powder
  • Disk
  • Aerosol Powder

Therapeutic Class: Anti-Inflammatory

Pharmacologic Class: Adrenal Glucocorticoid

Uses For fluticasone

Fluticasone belongs to the family of medicines known as corticosteroids (cortisone-like medicines). It is used to help prevent the symptoms of asthma. When used regularly every day, inhaled fluticasone decreases the number and severity of asthma attacks. However, it will not relieve an asthma attack that has already started.

Slideshow: Asthma - 10 Things You Need To Do To Keep It In Check

Inhaled fluticasone works by preventing certain cells in the lungs and breathing passages from releasing substances that cause asthma symptoms.

fluticasone may be used with other asthma medicines, such as bronchodilators (medicines that open up narrowed breathing passages) or other corticosteroids taken by mouth.

fluticasone is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in the product labeling, fluticasone propionate is used in certain patients with the following medical conditions:

  • Pulmonary disease, chronic obstructive

Before Using fluticasone

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For fluticasone, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to fluticasone or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Corticosteroids taken by mouth or injection have been shown to slow or stop growth in children and cause reduced adrenal gland function. If enough fluticasone is absorbed following inhalation, it is possible it also could cause these effects. Your doctor will want you to use the lowest possible dose of fluticasone that controls asthma. This will lessen the chance of an effect on growth or adrenal gland function. It is also important that children taking fluticasone visit their doctors regularly so that their growth rates may be monitored. Children who are taking fluticasone may be more susceptible to infections, such as chickenpox or measles. Care should be taken to avoid exposure to chickenpox or measles. If the child is exposed or the disease develops, the doctor should be contacted and his or her directions should be followed carefully. Before fluticasone is given to a child, you and your child's doctor should talk about the good fluticasone will do as well as the risks of using it.

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of inhaled fluticasone in the elderly. However, elderly patients may be more sensitive to the effects of fluticasone than younger adults, which may require caution in patients receiving inhaled fluticasone.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking fluticasone, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using fluticasone with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Atazanavir
  • Boceprevir
  • Bupropion
  • Carbamazepine
  • Ceritinib
  • Clarithromycin
  • Cobicistat
  • Conivaptan
  • Dabrafenib
  • Darunavir
  • Eslicarbazepine Acetate
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Piperaquine
  • Pixantrone
  • Posaconazole
  • Primidone
  • Ritonavir
  • Saquinavir
  • Siltuximab
  • Telaprevir
  • Telithromycin
  • Tipranavir
  • Voriconazole

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of fluticasone. Make sure you tell your doctor if you have any other medical problems, especially:

  • Herpes simplex (virus) infection of the eye or
  • Infections (virus, bacteria, or fungus)—Inhaled fluticasone may make these infections worse.
  • Tuberculosis (active or history of)—Inhaled fluticasone may cause this infection to start up again.

Proper Use of fluticasone

Inhaled fluticasone is used to prevent asthma attacks. It is not used to relieve an attack that has already started. For relief of an asthma attack that has already started, you should use another medicine. If you do not have another medicine to use for an attack or if you have any questions about this, check with your health care professional.

Use fluticasone only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of side effects. The full benefit of fluticasone may take 1 to 2 weeks or longer to achieve.

In order for fluticasone to help prevent asthma attacks, it must be used every day in regularly spaced doses, as ordered by your doctor.

Gargling and rinsing your mouth with water after each dose may help prevent hoarseness, throat irritation, and infection in the mouth. However, do not swallow the water after rinsing.

Inhaled fluticasone is used with a special inhaler and usually comes with patient directions. Read the directions carefully before using fluticasone. If you do not understand the directions or you are not sure how to use the inhaler, ask your health care professional to show you what to do. Also, ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly.

For patients using the inhalation aerosol:

  • When you use the inhaler for the first time, or if you have not used it for 4 weeks or longer, it may not deliver the right amount of medicine with the first puff. Therefore, before using the inhaler, prime it by spraying the medicine into the air four times. (Spray the inhaler once into the air if it has not been used in 1 to 3 weeks.) The inhaler will now be ready to give the right amount of medicine when you use it.
  • To use the inhaler:
    • Shake the inhaler well for 15 seconds immediately before each use.
    • Take the cap off the mouthpiece (the strap will stay attached to the actuator). Check the mouthpiece and remove any foreign objects. Make sure the canister is fully and firmly inserted into the actuator.
    • Hold the mouthpiece away from your mouth and breathe out slowly and completely.
    • Use the inhalation method recommended by your doctor.
      • Open-mouth method—Place the mouthpiece about 1 or 2 inches (two fingerwidths) in front of your widely opened mouth. Make sure the inhaler is aimed into your mouth so that the spray does not hit the roof of your mouth or your tongue.
      • Closed-mouth method—Place the mouthpiece in your mouth between your teeth and over your tongue, with your lips closed tightly around it. Do not block the mouthpiece with your teeth or tongue.
    • Tilt your head back a little. Start to breathe in slowly and deeply through your mouth and, at the same time, press the top of the canister one time to get one puff of the medicine. Continue to breathe in slowly for 5 to 10 seconds. Count the seconds while inhaling. It is important to press the top of the canister and breathe in slowly at the same time so the medicine is pulled into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being used correctly.
    • Hold your breath as long as you can up to 10 seconds. This gives the medicine time to settle in your airways and lungs. Take the mouthpiece away from your mouth and breathe out slowly.
    • If your doctor has told you to inhale more than one puff of medicine at each dose, wait about 30 seconds and then gently shake the inhaler again, and take the second puff following exactly the same steps you used for the first puff.
    • When you are finished, wipe off the mouthpiece and replace the cover to keep the mouthpiece clean and free of foreign objects.
  • The inhaler has a dose counter that keeps track of how many more times you can use it before you need to open a new one. When the dose counter reaches "020", call your doctor or pharmacist if refill is needed .
  • If the dose counter is not working correctly, do not use the inhaler and return it to your pharmacy or doctor. Do not change the numbers or remove the counter from the canister .
  • Clean the inhaler and mouthpiece at least once a day to prevent buildup of medicine and blockage of the mouthpiece.
    • To clean the inhaler:
      • Remove the metal canister from the inhaler and set it aside.
      • Rinse the mouthpiece and cover and plastic case in warm, running water.
      • Shake off the excess water and let the inhaler parts air dry completely before replacing the metal canister and cover.

For patients using the powder for inhalation:

  • To load the inhaler:
    • Make sure your hands are clean and dry.
    • Do not insert the disk until just before you are ready to use the medicine.
    • Take off the mouthpiece cover and make sure that the mouthpiece is clean.
    • Hold the corners of the white tray and pull out gently until you can see all of the plastic ridges on the sides of the tray.
    • Put your finger and thumb on the ridges, squeeze inward, and gently pull the tray out of the body of the inhaler.
    • Place a disk on the wheel with the numbers facing up, and then slide the tray back into the inhaler.
    • Hold the corners of the tray and slide the tray out and in. This will rotate the disk.
    • Continue to turn the disk in this way until the number 4 appears in the small window. Each disk has four blisters containing the medicine. The window will display how many inhalations you have left after you use it each time. For example, when you see the number 1, you have one inhalation left.
    • To replace the empty disk with a full disk, follow the same steps you used to load the inhaler. Do not throw away the wheel when you discard the empty disk.
  • To use the inhaler:
    • Hold the inhaler flat in your hand. Lift the rear edge of the lid until it is fully upright.
    • The plastic needle on the front of the lid will break the blister containing one inhalation of medicine. When the lid is raised as far as it will go, both the upper and the lower surfaces of the blister will be pierced. Do not lift the lid if the cartridge is not in the inhaler. Doing this will break the needle and you will need a new inhaler.
    • After the blister is broken open, close the lid. Keeping the inhaler flat and well away from your mouth, breathe out to the end of a normal breath.
    • Raise the inhaler to your mouth, and place the mouthpiece in your mouth.
    • Close your lips around the mouthpiece and tilt your head slightly back. Do not bite down on the mouthpiece. Do not block the mouthpiece with your teeth or tongue. Do not cover the air holes on the side of the mouthpiece.
    • Breathe in through your mouth as steadily and as deeply as you can until you have taken a full deep breath.
    • Hold your breath and remove the mouthpiece from your mouth. Continue holding your breath as long as you can up to 10 seconds before breathing out. This gives the medicine time to settle in your airways and lungs.
    • Hold the inhaler well away from your mouth and breathe out to the end of a normal breath.
    • Prepare the cartridge for your next inhalation. Pull the cartridge out once and push it in once. The disk will turn to the next numbered dose as seen in the indicator window. Do not pierce the blister until just before the inhalation.
    • If your doctor has told you to inhale more than one puff of medicine at each dose, take the second puff following exactly the same steps you used for the first puff.
    • When you are finished, wipe off the mouthpiece and replace the cover to keep the mouthpiece clean and free of foreign objects.
  • To clean the inhaler:
    • Remove the tray from the body of the inhaler.
    • Hold the wheel between your forefinger and thumb and pull upward to separate it from the tray.
    • Use the brush that is stored in the rear of the body of the inhaler to brush away any powder left behind on the parts of the inhaler.
    • Replace the wheel and push it down firmly until it snaps back into place.
    • Replace the tray and mouthpiece cover.
    • Separate the parts of the inhaler using the steps outlined above.
    • Rinse the parts of the inhaler with warm water and let them air dry before reassembling them as described above.
    The inhaler should be cleaned once a week.

Dosing

The dose of fluticasone will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of fluticasone. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For bronchial asthma
    • For inhalation aerosol:
      • Adults and children 12 years of age and older—88 to 880 micrograms (mcg) two times a day, morning and evening.
      • Canadian labeling recommends—For adults and children 16 and older: 100 to 1000 mcg two times a day.
      • Children 4 to 11 years of age—88 mcg two times a day.
      • Canadian labeling recommends—For children 4 to 16 years of age: 50 to 100 mcg two times a day; For children up to 4 years of age: Use and dose must be determined by your doctor.
      • Children younger than 4 years of age—Use and dose must be determined by your doctor .
    • For powder for inhalation:
      • Adults and children older than 11 years of age—100 to 1000 mcg two times a day.
      • Children 4 to 11 years of age—50 to 100 mcg two times a day.
      • Canadian labeling recommends—For children 4 to 16 years of age: 50 to 100 mcg two times a day.
      • Children younger than 4 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of fluticasone, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Store the canister at room temperature, away from heat and direct light. Do not freeze. Do not keep fluticasone inside a car where it could be exposed to extreme heat or cold. Do not poke holes in the canister or throw it into a fire, even if the canister is empty.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using fluticasone

Check with your doctor if:

  • You go through a period of unusual stress to your body, such as surgery, injury, or infection.
  • You have an asthma attack that does not improve after you take a bronchodilator medicine.
  • Your asthma symptoms do not improve or your condition worsens.
  • You are exposed to the chickenpox or measles.

Your doctor may want you to carry a medical identification card stating that you are using fluticasone and that you may need additional medicine during times of emergency, a severe asthma attack or other illness, or unusual stress.

Before you have any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are using fluticasone.

fluticasone Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • White patches in mouth and throat
Less common
  • Diarrhea
  • ear ache
  • fever
  • lower abdominal pain
  • nausea
  • pain on passing urine
  • redness or discharge of the eye, eyelid, or lining of the eye
  • shortness of breath
  • sore throat
  • trouble in swallowing
  • vaginal discharge (creamy white) and itching
  • vomiting
Rare
  • Blindness, blurred vision, eye pain
  • large hives
  • bone fractures
  • diabetes mellitus [increased hunger, thirst, or urination]
  • excess facial hair in women
  • fullness or roundness of face, neck, and trunk
  • growth reduction in children or adolescents
  • heart problems
  • high blood pressure
  • hives and skin rash
  • impotence in males
  • lack of menstrual periods
  • muscle wasting
  • numbness and weakness of hands and feet
  • weakness
  • swelling of face, lips, or eyelids
  • tightness in chest, troubled breathing, or wheezing
Incidence not known
  • Difficulty breathing
  • difficulty swallowing
  • dizziness
  • fast heartbeat
  • growth rate decreased in children and teenagers
  • itching, puffiness, or swelling of the eyelids or around the eyes, face, lips, or tongue
  • noisy breathing
  • swelling of the mouth or throat
Symptoms of overdose
  • Darkening of skin
  • fainting
  • loss of appetite
  • mental depression
  • unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Cough
  • general aches and pains or general feeling of illness
  • greenish-yellow mucus in nose
  • headache
  • hoarseness or other voice changes
  • runny, sore, or stuffy nose
Less common
  • Bloody mucus or unexplained nosebleeds
  • dizziness
  • eye irritation
  • feeling 'faint'
  • giddiness
  • irregular or painful menstrual periods
  • irritation due to inhalant
  • joint pain
  • migraines
  • mouth irritation
  • muscle soreness, sprain, or strain
  • sneezing
  • stomach pain or burning
Rare
  • Aggression
  • agitation
  • bruising
  • itching
  • restlessness
  • weight gain
Incidence not known
  • Abdominal pain
  • blurred vision
  • decrease in height
  • dry mouth
  • fatigue
  • flushed, dry skin
  • fruit-like breath odor
  • increased hunger
  • increased thirst
  • increased urination
  • loss of voice
  • pain in back, ribs, arms or legs
  • sweating
  • trouble sitting still
  • unexplained weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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