Fluticasone (Inhalation)

Overview

Fluticasone is a drug that belongs to a class called corticosteroids. It works by reducing swelling and irritation in the lung's airways so that the patient can breathe more easily.

Patients with asthma should have both controller drugs as well as quick-relief drugs. The former is used daily, optimally at intervals that are equally spaced, in order to help control and decrease asthma attacks and their symptoms. The latter class of drugs helps provide instant relief from asthma attacks. If patients have a difficult time remembering to take their medicine, they can try methods such as taking their medicine at the same time each day, or by marking down their dosage schedule on an easily accessible calendar.

As different inhalers have different instructions, patients should familiarize themselves with the procedures required to operate their inhalers. If they have any questions, they should clarify them with their doctors before starting treatment with fluticasone.

Used correctly, fluticasone can help patients to live a normal and active life, reducing the time that may have to be taken off work, school, or even their leisure hours.

Conditions Treated

  • Symptoms of asthma

Type Of Medicine

  • Corticosteroids

Side Effects

While using fluticasone, as with many other medicines, there is a chance that patients may encounter side effects. However, not all patients using this medicine will experience side effects, if any, and the medication is often prescribed if the doctor feels that the medicine is more beneficial than any possibility of side effects.

These side effects range from mild to serious. If the patient notices any of them occurring, they should tell their doctor as soon as possible. They should do the same if they notice any unusual symptoms that is not listed in this guide, as the following lists are not exhaustive. If the patient has any questions or doubts they should consult their doctor before starting fluticasone.

Milder side effects may not require medical attention, unless they persist or become worse, in which case the patient should seek medical help. These effects include:

  • Hoarseness or changes in voice

More serious side effects which may require prompt medical attention include:

  • White patches in the mouth or on the tongue

While rare, fluticasone may also cause trouble in breathing or severe and sudden wheezing upon or immediately after use. In such a case, the patient should use a quick-relief inhaler right away and seek immediate medical help.

It is also rare that patients will experience a severe allergic reaction to fluticasone. However, they should be on the lookout for the following signs of allergy:

  • Rashes

Dosage

Fluticasone in its inhaled form is prescribed to prevent asthma attacks, and should not be used to relieve an asthma attack that has already started. Patients should have another medication prescribed solely for treating asthma attacks that have already started. If they do not have a quick-relief medication, they should approach their doctor to discuss the issue. Patients who find that they are using their quick-relief inhalers often (above two times a week) or that their inhalers are not working well should also check in with their doctor. It is imperative that patients learn which breathing problems can be solved by themselves and which breathing problems require immediate medical help.

Patients should follow their doctor's instructions closely when using this medicine; they should use only the amount that has been prescribed, and at the dosing schedule that they have been assigned. They should not start, stop or change the amount of any medication they are taking, including fluticasone, without their doctor's consent or knowledge, as it may elevate risks of side effects, or cause the medication to not work properly. This is especially true if the patient has been taking a different corticosteroid (such as prednisone), as they may experience withdrawal symptoms if they stop using the drug suddenly. Certain conditions such as asthma or allergies may worsen if the patient stops their medication abruptly. In order to prevent these withdrawal symptoms, which can include nausea, headaches and weakness, the doctor may lower the dose of the previous medication slowly after the patient has started using fluticasone.

It may take one to two weeks, or even longer, for the full benefits of the medicine to be apparent. Patients should take fluticasone every day at regularly timed intervals so that the medicine is able to work optimally to help prevent asthma attacks. When taking the medicine, the patient may not feel or taste the medication, but this is normal. They should inhale each dose of medicine deeply so that they receive the correct amount of medicine into their lungs.

As the use of fluticasone can cause hoarseness or irritation of the throat, as well as infections in the mouth, patients are recommended to gargle and rinse their mouths with water after each dose to help avoid these side effects. They should spit the water out after rinsing and be careful to not swallow it.

Prior to using fluticasone, patients should read all available information they have or are given on the medicine. This may come with the medicine packaging, or be available from their doctor. If they have any questions or doubts, about the medicine or its usage, they should clarify them with their doctor before taking the medicine. These questions can include how to use the inhaler properly. The inhaler should not be taken apart or altered in any form.

Fluticasone comes in a few different forms, and the average dosage and uses are listed here. If the patient's usage differs from this guide, they should check with their doctor before proceeding. Patients who have been prescribed two puffs or more per dose should wait between 30 seconds to a minute in between inhalations. If they have been prescribed different medicines in inhalers, they should wait for at least a minute in between their medications.

Using the Arnuityâ„¢ Ellipta®:

  • Peel back the lid of the foil tray of the medication to open it

Using the Flovent® HFA inhaler:

  • The Flovent® HFA inhaler may not be able to deliver the correct amount of medicine required on the first puff, if it has not been used before, or if it has not been used in more than four weeks. Patients should, in this case, spray the medicine into the air for four times in order to prime the inhaler.

Not every patient will have the exact same dosage. Their doses may differ based on their conditions and needs, which the doctor will determine. The following lists an average dose. If the patient has a different dosage or dose schedule from the list, they should not change it without consulting their doctor.

Inhalation dosage form (aerosol):

  • Adults and children aged 12 and above: 88 to 880 micrograms (mcg) twice a day, to be taken in the morning and evening

Inhalation dosage form (powder):

  • Adults and children aged 12 and above: 100mcg for an initial dose. The dose may be adjusted by the doctor as required, though it does not usually go above 200mcg a day.

If the patient has missed a dose, they should take it as soon as possible, unless it is almost time for the next dose, in which case they should skip their missed dose and resume the next dose. They should not double dose.

Patients who think they may have overdosed should keep an eye out for the following symptoms and seek emergency medical help from either their doctor or local poison control center:

  • Darkening of the skin

Interactions

Drugs may interact with each other to cause unwanted effects or affect the effectiveness of the medication. They may also interact with various supplements or herbal products. Patients should keep a list of drugs, supplements or herbal products that they are currently consuming or have recently consumed so that they can share them with their doctor or pharmacist to help prevent such interactions. These drugs may be both prescription or non-prescription, i.e. over-the-counter.

On some occasions, medicines that interact with each other may be prescribed together by the doctor if they feel that it is necessary or if the interactions may be of benefit. In these cases, the patient may wish to discuss the issue with their doctor, and if there are certain actions they can take in order to minimize the risk of any unwanted side effects developing.

The following is a non-exhaustive list of drugs that may more commonly interact with fluticasone:

  • Acetaminophen

Certain medical conditions may also affect how fluticasone is used. Patients should share their medical history with their doctor, especially if they have or have had the following:

  • Hepatic impairment

While on medications, patients are advised to refrain from foods and products such as alcohol and tobacco, as these items are likely to interact with most medications. If in doubt, the patient should check with their doctor the usage of these products, especially if they drink or smoke regularly.

Warnings

While fluticasone is used to help decrease the incidence of asthma attacks, it may also conversely increase chances of a severe asthma attack in the event that it does occur. It can also cause paradoxical bronchospasm, which can be fatal. The patient may notice their breathing or wheezing getting worse. Patients should talk to their doctor about this possibility and how they may combat it.

It is important that the doctor conduct regular checks on the patient's progress if they are prescribed the medicine for a long period of time. This is to ensure that the medicine is working as intended, and to check that unwanted side effects are not developing, or to help decrease the effects if they do occur.

Fluticasone should not be used if the asthma attack has already started, as it is a controller drug. The patient should use their quick-relief or short-acting inhaler if they have an acute asthma attack. They should also ensure that they are familiar with the procedure of using their quick-relief inhaler.

If the patient's symptoms do not improve after two weeks or worsen, they should seek medical care as soon as possible. They should also do the same if they notice that they are using their quick-relief inhaler more often than usual, or if the inhaler does not seem to work as well as it did previously. For example, the patient may notice that they finish an entire canister with their inhaler in a shorter period of time, or that they need to use four or more inhalations for more than two days in a row. A large decrease in the patient's peak flow will also require immediate medical attention.

The use of fluticasone may cause thrush in the mouth or throat, which is an oral infection. Patients who experience white patches in the mouth or throat, or pain during eating and swallowing, should contact their doctors right away to treat the infection.

Patients may be required to carry a medical identification card which will state that the patient is using this medication and that they may require additional medicines in the case of an emergency, an asthma attack, other illnesses or unusual stresses.

Prolonged usage of fluticasone may elevate the patient's risk of encountering problems with their adrenal gland. Patients should look out for the following symptoms, and discuss the issue with their doctor as quickly as possible:

Another associated risk with a long period of usage with fluticasone is a decreased density of bone minerals, which can lead to osteoporosis or weak bones.

While allergic reactions are rare, patients should check with their doctor as soon as possible, and stop using their medication if they experience hives, rashes on their skin, or other allergic reactions.

As fluticasone can lead to a higher chance of problems with vision, the patient may be advised to have their eyes checked by an ophthalmologist or an eye doctor. They should take note if they encounter any problems with their vision, such as having blurred vision or having difficulties with reading.

With children, fluticasone or other corticosteroids may cause delayed or even stopped growth, as well as interfere with adrenal gland functions. It is advised that children use the lowest dose of fluticasone possible. They may also be more vulnerable to infections such as chickenpox or measles while they are under treatment with this medicine; it is advised that extra precautions should be taken to avoid exposing these children to such diseases. Parents or caretakers of children who are taking fluticasone should talk to their child's doctor if they have any doubts or queries, and to discuss the benefits of taking this medication versus its negative effects.

Fluticasone has not been shown to work differently with elderly patients. However, they may be at higher risk of age-related diseases such as liver, kidney or heart problems, which may necessitate a change in the dose and usage of this medication.

Storage

Fluticasone should be kept in its foil pouch until it is required. The canister should be stored at room temperature, in a cool and dry place, away from direct light. It should not be exposed to freezing temperatures or kept in potentially humid environments such as the bathroom. This medicine should also not be kept in the car where it could be exposed to extreme temperatures.

The canister should be kept intact. It should not be disposed of by throwing it into a fire, even if it is emptied.

Once the medicine is expired or unwanted, the patient should dispose of it properly as soon as possible. If they are unsure on how to handle medical waste, they should consult their doctor or their local waste management.

This medicine should be kept out of reach of children and animals at all times.

Summary

Fluticasone belongs to a class of drugs known as corticosteroids, which mimic the function of cortisone in the body. It is used as a controller drug to help treat symptoms of asthma, and to help decrease the incidence of asthma attacks, although it should not be used in the case of an asthma attack which has already started. The patient should use another form of medication, which is a quick-relief inhaler, in this case.

It is most effective when patients use this medication every day at evenly spaced intervals, according to the prescriptions that they have been given.

Patients should make sure that they know how to use their inhalers correctly, and to take note of the dosages left in their inhalers via the counter that is available as part of the packaging. They should check if they require refills and if they know the proper ways to dispose of their medicine once it is no longer needed.

In order to help the correct amount of medication reaching the lungs, patients should breathe slowly and gently through their mouths when inhaling their doses, and wait about a minute in between puffs if they have been prescribed more than one puff per dose, or if they are using different inhalers and medications.

Parents or caretakers of children who have been prescribed fluticasone should discuss the usage and dose with their doctors as the medicine may stunt or stop the growth of the children, especially with prolonged usage.

This medicine can also cause issues such as paradoxical bronchospasm, osteoporosis and problems with the adrenal gland functions. Patients who have had or are having problems with these conditions should let their doctor know before they start the medication.

Used correctly, however, and with regular checks by their doctor to help ensure that the medication is working as intended, fluticasone helps patients to live a normal and active life that can include activities such as exercise.