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Here’s what to ask a doctor about hereditary angioedema

Fluticasone (Topical)

Pronunciation

Pronunciation

(floo TIK a sone)

Index Terms

  • Fluticasone Propionate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External, as propionate:

Cutivate: 0.05% (30 g, 60 g) [contains cetyl alcohol, propylene glycol]

Generic: 0.05% (15 g, 30 g, 60 g)

Lotion, External, as propionate:

Cutivate: 0.05% (120 mL) [contains cetostearyl alcohol, methylparaben, propylene glycol, propylparaben]

Generic: 0.05% (60 mL, 120 mL)

Ointment, External, as propionate:

Cutivate: 0.005% (30 g [DSC], 60 g [DSC])

Generic: 0.005% (15 g, 30 g, 60 g)

Brand Names: U.S.

  • Cutivate

Pharmacologic Category

  • Corticosteroid, Topical

Pharmacology

Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Fluticasone has intermediate range potency.

Absorption

Percutaneous absorption is variable and dependent upon many factors including vehicle used, integrity and thickness of epidermis, surface area of application, and use of occlusive dressings (not recommended)

Use: Labeled Indications

Dermatoses:

Lotion: For the relief of the inflammatory and pruritic manifestations of atopic dermatoses in patients 3 months of age or older.

Cream and ointment: For the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses in patients 3 months of age or older. Ointment is indicated for use in adults only.

Contraindications

Cream and ointment: Hypersensitivity to fluticasone or any component of the formulation.

Lotion: There are no contraindications listed in the manufacturer's labeling.

Dosing: Adult

Corticosteroid-responsive dermatoses: Topical: Cream, ointment: Apply a thin film to affected area twice daily. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary.

Atopic dermatitis: Topical:

Cream: Apply a thin film to affected area 1 to 2 times daily. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary.

Lotion: Apply a thin film to affected area once daily. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Corticosteroid-responsive dermatoses: Topical: Cream: Infants ≥3 months, Children, and Adolescents: Refer to adult dosing.

Atopic dermatitis: Topical: Cream, lotion: Infants ≥3 months, Children, and Adolescents: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Administration

Topical: Apply sparingly in a thin film. Rub in lightly. Avoid contact with eyes; generally not for routine use on the face, underarms, or groin area. Unless otherwise directed by healthcare professional, do not use with occlusive dressing; do not use on children’s skin covered by diapers or plastic pants.

Storage

Cream and ointment: Store at 2°C to 30°C (36°F to 86°F).

Lotion: Store at 15°C to 30°C (59°F to 86°F); do not refrigerate; keep tightly sealed.

Drug Interactions

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination

Ceritinib: Corticosteroids may enhance the hyperglycemic effect of Ceritinib. Monitor therapy

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Monitor therapy

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification

Adverse Reactions

1% to 10%:

Central nervous system: Numbness of fingers (1%)

Dermatologic: Telangiectasia (children: 2% to 5%), pruritus (3%), skin irritation (3%), erythematous rash (children: 2%), exacerbation of eczema (2%), infected eczema (1%), xeroderma (1%)

<1% (Limited to important or life-threatening): Acneiform eruption, blurred vision, common warts, Cushing’s syndrome, dermatitis, edema, folliculitis, hemorrhage, hyperglycemia, immunosuppression, leukopenia, secondary infection, sepsis, skin atrophy, skin discoloration, thrombocytopenia, urticaria

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.

• Contact dermatitis: Allergic contact dermatitis can occur and is usually diagnosed by failure to heal rather than clinical exacerbation; discontinue fluticasone if appropriate.

• Localized reactions: May cause local reactions, including skin atrophy; risk increased with use under occlusion.

• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.

Disease-related concerns:

• Skin infections: Use appropriate antibacterial or antifungal agents to treat concomitant skin infections; discontinue treatment if infection does not resolve promptly.

Special populations:

• Pediatric: Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients. Safety and efficacy of lotion and cream (in children) beyond 4 weeks of use have not been established.

Dosage form specific issues:

• Lotion and cream: Contain imidurea, an excipient; imidurea releases trace amounts of formaldehyde which may cause irritation or allergic sensitization upon contact with skin. Discontinue lotion if irritation occurs and institute appropriate therapy.

Other warnings/precautions:

• Appropriate use: Avoid contact with eyes; generally not for routine use on the face, underarms, or groin area (including diaper area). Avoid use with occlusive dressing unless directed by a health care provider. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary.

Monitoring Parameters

Growth (adolescents and children); signs/symptoms of HPA axis suppression/adrenal insufficiency; possible eosinophilic conditions (including Churg-Strauss syndrome); skin infections.

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed with systemic corticosteroids in animal reproduction studies. In general, the use of topical corticosteroids during pregnancy is not considered to have significant risk; however, intrauterine growth retardation in the infant has been reported (rare). The use of large amounts or for prolonged periods of time should be avoided.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience itching or redness. Have patient report immediately to prescriber signs of high blood sugar (confusion, feeling sleepy, more thirst, hunger, passing urine more often, flushing, fast breathing, or breath that smells like fruit), signs of skin changes (pimples, stretch marks, slow healing, or hair growth), moon face, muscle weakness, severe headache, vision changes, skin edema, dryness, severe burning, skin discoloration, skin thinning, or skin irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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