fluticasone propionate: clinical use

Prescribing considerations

• Confirm the route, formulation, indication and product-specific age licence.
• The selected inhaler is preventive asthma therapy, not an acute bronchodilator.
• Review total corticosteroid exposure, CYP3A inhibitors, transfer from systemic corticosteroids, application to large or occluded skin areas and prolonged treatment.
• Use particular caution on facial, broken or infected skin and where a nappy or dressing may act as occlusion.
• Unilateral nasal polyposis warrants specialist confirmation, and polyps require ongoing clinical assessment.

Contraindications and cautions

• Hypersensitivity to fluticasone propionate or product excipients.
• The selected Pirinase product lists concomitant HIV medicines as a contraindication.
• Selected skin products should not be used for untreated cutaneous infection, rosacea, acne vulgaris, perioral dermatitis, or non-inflammatory genital or perianal itching. Further product-specific restrictions and paediatric age limits apply.

Monitoring

• Assess asthma control, reliever use, inhaler technique and lung function where appropriate.
• Monitor growth in children receiving prolonged inhaled or intranasal corticosteroid treatment.
• Consider adrenal suppression and other systemic corticosteroid effects when exposure is high, multiple steroid routes are used or CYP3A inhibitors are present.
• Assess new visual disturbance for cataract, glaucoma or other corticosteroid-associated eye disease.
• During skin treatment, review response, infection, atrophy, rebound or withdrawal features and the extent of application.

Clinical pharmacology

Fluticasone propionate is a potent glucocorticoid with local anti-inflammatory activity. Swallowed medicine has negligible oral bioavailability because of poor absorption and extensive first-pass metabolism; systemic fluticasone is mainly cleared through CYP3A4 metabolism.

Formulation and product differences

• The pressurised metered-dose inhaler delivers medicine to the lungs for asthma prevention.
• The metered nasal spray is licensed for allergic rhinitis; the single-use nasal-drop suspension is licensed for nasal polyps and associated obstruction.
• Cream and ointment are potent topical corticosteroid preparations. Ointment is particularly suitable for dry, lichenified or scaly lesions; licences and minimum ages differ.
• Formulations are not interchangeable. Their excipients, administration techniques, age restrictions and contraindications differ.

Cream

Route: Cutaneous

Strengths: 0.05%

Ointment

Route: Cutaneous

Strengths: 0.005%

Nasal preparation

Route: Nasal

Strengths: 400 micrograms, 1 mg/mL, 0.05%