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Fluticasone propionate

Intranasal
Inhalation
Topical
Class
Steroid hormones
Subclass
Glucocorticoids
Substance name
Fluticasone propionate
Brand names
Xhance®
Common formulations
Nasal spray
See also
Fluticasone furoate (Flonase Sensimist®, Arnuity Ellipta®)
Dosage and administration
Adults patients
Symptomatic relief
Allergic rhinitis
•
Start at: 100-200 mcg IN daily for 1 week
•
Maintenance: 100-200 mcg IN daily for up to 6 months
Non-allergic rhinitis
•
Maintenance: 100-200 mcg IN daily, in 1-2 divided doses
•
Maximum: 200 mcg per day
Treatment
Chronic rhinosinusitis with nasal polyps
•
Maintenance: 186-372 mcg IN BID
•
Maximum: 744 mcg per day
Chronic rhinosinusitis without nasal polyps
•
Maintenance: 186-372 mcg IN BID
•
Maximum: 744 mcg per day
Other off-label uses
•
Symptomatic relief of allergic conjunctivitis
Indications for use
Labeled indications
Adults
•
Symptomatic relief of allergic rhinitis
•
Symptomatic relief of non-allergic rhinitis
•
Treatment of chronic rhinosinusitis with nasal polyps
•
Treatment of chronic rhinosinusitis without nasal polyps
Children
•
Treatment of non-allergic rhinitis
Off-label indications
Adults
•
Symptomatic relief of allergic conjunctivitis
Safety risks
Contraindications
Hypersensitivity to fluticasone propionate or its components
Concomitant use of strong CYP3A4 inhibitors
•
Do not use fluticasone proprionate with strong CYP3A4 inhibitors, such as ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, ketoconazole, telithromycin, conivaptan, lopinavir, nefazodone, and voriconazole.
Warnings and precautions
Corticosteroid withdrawal, adrenal insufficiency
•
Do not discontinue abruptly in patients taking the drug for a prolonged period. Use caution when transferring patients from systemic corticosteroid therapy.
Cushing's syndrome, adrenal suppression
•
Use caution in patients receiving high doses or susceptible patients receiving regular doses.
Decreased bone mineral density
•
Maintain a high level of suspicion, as long-term corticosteroid use has been associated with an increased risk of osteopoenia and osteoporosis.
Glaucoma, cataract
•
Use caution in patients with a change in vision or a history of increased intraocular pressure, glaucoma, and/or cataracts.
Growth delay
•
Use caution in pediatric patients. Monitor growth.
Immunosuppression
•
Use caution in patients with active or latent tuberculous, systemic fungal, bacterial, viral, or parasitic infections, or ocular herpes simplex.
Local nasal adverse reactions
•
Maintain a high level of suspicion, as fluticasone propionate has been associated with epistaxis, nasal ulceration, nasal septal perforation, impaired wound healing, and Candida infection. Avoid use in patients with recent nasal ulcers, nasal surgery, or nasal trauma.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
No guidance available.
Renal replacement therapy
Any modality
•
No guidance available.
Hepatic impairment
Any severity
•
Use with caution. Monitor for adverse reactions.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Headache, nosebleed
Common 1-10%
•
Bronchitis, nasal mucosal erythema, nasal ulcers, nasopharyngitis, pharyngitis, cough, nasal congestion, nasal dryness, throat pain, dental pain, dizziness, abdominal discomfort, weight gain, ↑ intraocular pressure, runny nose, abdominal pain, diarrhea, fever, flu-like symptoms, nasal irritation, nausea, vomiting, sinusitis
Unknown frequency
•
Central serous chorioretinopathy, cataracts, anaphylaxis, immunosuppression, adrenal suppression, Cushing's syndrome, adrenal insufficiency, anaphylactoid reactions, glaucoma, dysphonia, skin rash, itching, ↓ bone mineral density, growth delay, angioedema, urticaria, bronchospasm, wheezing, dyspnea, change in taste, reduced sense of smell, change in voice, blurred vision, conjunctivitis
Interactions
Drug(s)
Check Interactions
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