GENERIC NAME: fluticasone propionate oral inhaler
DRUG CLASS AND MECHANISM: Fluticasone propionate is a man-made steroid of the glucocorticoid family which is related to the naturally-occurring steroid hormone, cortisol or hydrocortisone, produced by the adrenal glands. Glucocorticoid steroids have potent anti- inflammatory actions. When used as an inhaler, fluticasone propionate goes directly to the airways of the lung. In asthmatic patients, the suppression of inflammation within the airways reduces the spasm that narrows the airways and makes getting air into and out of the lungs difficult. When used in lower doses, very little fluticasone propionate is absorbed into the body. When higher doses are used, fluticasone is absorbed and may cause side effects elsewhere in the body.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Inhalation aerosol unit in 44 μg, 110 μg or 220 μg per actuation.

STORAGE: Fluticasone propionate should be kept at room temperature, 4-30°C (39-86°F) and should be shaken well before each use.

PRESCRIBED FOR: Fluticasone propionate is used for the control of asthma in persons requiring continuous treatment. Such patients may include those with frequent asthmatic episodes requiring medications to dilate (expand) airways or those with asthmatic episodes at night.

DOSING: Doses vary from patient to patient, but recommendations for inhalation are similar for most corticosteroids including fluticasone propionate. The canister containing the fluticasone propionate should be shaken well before administering. The lungs are emptied of air by breathing out completely. The mouthpiece is placed between the open lips, and the lips are closed firmly around the mouthpiece. The canister's actuating valve is depressed one time while breathing in deeply and slowly. The breath is held for a count of 10, and then normal breathing is resumed. If more than a single inhalation is prescribed, a minute should pass between inhalations.

A tube acting as a spacer, which can be attached to the canister, may be helpful for persons who are unable to coordinate breathing in and pressing down on the canister's valve. Following administration, the mouth should be rinsed thoroughly with water or mouthwash which is then spit out to minimize dry mouth, irritation of the throat, and hoarseness. The inhaler must be cleaned frequently by removing the canister and cap from the inhaler and then rinsing the inhaler with warm water and drying it.

If a bronchodilator aerosol spray (a spray that causes the airways to expand), for example, albuterol (Proventil; Ventolin), is used, it should be used first, and then 5 - 15 minutes later the fluticasone propionate should be used.

DRUG INTERACTIONS: No drug interactions have been described with inhaled fluticasone propionate.

PREGNANCY: Adequate and well-controlled studies regarding the use of fluticasone during pregnancy have not been done. Fluticasone use during pregnancy should be avoided unless the potential benefit justifies the potential but unknown risk to the fetus.

NURSING MOTHERS: It is not known if fluticasone propionate is secreted in breast milk. Other medications in the same class as fluticasone propionate are secreted into breast milk. It is not known whether the small amounts that may appear in the milk are of consequence to the infant.

SIDE EFFECTS: The most commonly noted side effects associated with inhaled fluticasone propionate are mild cough or wheezing; these effects may be minimized by using a bronchodilator inhaler (e.g. albuterol or Ventolin) first. Oral candidiasis or thrush (a fungal infection) may occur in between 1 in 50 and 1 in 20 persons who use fluticasone propionate (without a spacer), the risk being higher with higher doses. The risk for candidiasis in children is lower than in adults. Using a spacer and washing the mouth out with water following each use reduces the risk of candidiasis. Hoarseness may also occur, and here also, a spacer and washing the mouth out with water following each use reduces the risk.

High doses of inhaled glucocorticoids may decrease formation and increase break-down of bone thereby weakening bones and promoting fractures. Still higher doses may cause suppression of the body's ability to make its own natural glucocorticoid in the adrenal gland. It is possible that these effects are shared by higher-dose fluticasone propionate. People with suppression of their adrenal glands (which can be diagnosed by a doctor) would need increased amounts of glucocorticoids, probably by the oral or intravenous route, during periods of high physical stress when glucocorticoids are particularly important.