fluticasone propionate + formoterol: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
fluticasone propionate + formoterol: clinical details
Prescribing considerations
- Confirm that combination maintenance therapy is appropriate; this product is not intended for initial treatment of mild asthma, acute symptom relief or COPD.
- Do not initiate during an acute exacerbation or rapidly deteriorating asthma.
- Check adherence, pMDI technique and coordination. If required, use the product-specified spacer and reassess clinical response.
- Use cautiously with active or previous pulmonary tuberculosis, respiratory infection, diabetes, thyrotoxicosis, phaeochromocytoma, hypokalaemia, QT prolongation, severe cardiovascular disease or severe hepatic impairment.
- Avoid abrupt withdrawal because asthma may worsen.
Contraindications and cautions
- Hypersensitivity to fluticasone propionate, formoterol fumarate or any excipient.
Monitoring
- Asthma symptoms, exacerbations, reliever use and lung function.
- Adherence, inhaler technique, dose-indicator status and mouth or throat adverse effects.
- Height during prolonged treatment in children.
- Blood glucose in people with diabetes when clinically indicated.
- Serum potassium when hypokalaemia risk is increased.
- Features of systemic corticosteroid exposure or adrenal suppression when risk factors are present.
- Persistent visual symptoms, with ophthalmic assessment where indicated.
Clinical pharmacology
Fluticasone propionate is a locally active synthetic glucocorticoid with extensive first-pass metabolism and negligible oral systemic bioavailability. Formoterol is a selective long-acting beta2 agonist acting locally as a bronchodilator.
Formulation and product differences
- Press-and-breathe pMDI suspensions with an integrated, colour-coded dose indicator.
- Three strengths are available. The lowest is licensed from age five, the middle from age twelve and the highest for adults only.
- Contains ethanol, a small non-pharmacological quantity of sodium cromoglicate and HFA-227 propellant.
- After opening the foil pouch, the stated in-use shelf life is three months. Protect from freezing and excessive heat.
fluticasone propionate + formoterol preparations and strengths
Inhaled preparation
Route: Inhaled
Strengths: 50 micrograms + 5 micrograms, 125 micrograms + 5 micrograms, 250 micrograms + 10 micrograms/actuation
fluticasone propionate + formoterol interactions
Tell the prescriber and pharmacist about all prescribed, non-prescribed and inhaled products. Important interactions include:
Potent CYP3A inhibitors, including ritonavir, cobicistat, ketoconazole, itraconazole and clarithromycin
May increase systemic fluticasone exposure and corticosteroid adverse effects.
Beta-blockers, including timolol eye drops
Can oppose formoterol and provoke severe bronchospasm.
Other long-acting beta2 agonists
May cause additive beta-agonist effects and should not be used concurrently.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.