Fluticasone

What Does Fluticasone Do?

Fluticasone, a synthetic corticosteroid, is primarily used for treating conditions such as asthma, allergic rhinitis, and nasal polyps. It mitigates inflammation in the airways and nasal passages, aiding improved breathing and reducing symptoms like wheezing, shortness of breath, runny nose, and sneezing. Off-label uses may involve the treatment of eczema, psoriasis, or severe hives.

How Does Fluticasone Work? (the complicated bit)

Fluticasone functions through binding to glucocorticoid receptors in cells. This instigates a range of anti-inflammatory effects including suppression of inflammatory gene expression, reduction of immune cell migration to inflamed sites, and inhibition of pro-inflammatory cytokines.

Drug Type and Category of Fluticasone

Fluticasone is a corticosteroid medication that falls under the category of inhaled corticosteroids (ICS) when used in inhaler form, and topical corticosteroids when used in creams, ointments, or nasal sprays.

What dosage of Fluticasone should you be taking?

NICE Dosage Guidelines ¹

Inhaled Fluticasone Dosage

Fluticasone Propionate (Inhaler)

• Low Dose: 100 to 250 micrograms per day in 2 divided doses.
• Moderate Dose: 300 to 500 micrograms per day in 2 divided doses.
• High Dose: 600 to 1,000 micrograms per day in 2 divided doses.

For adults aged 17 years and older with severe asthma, doses above 1,000 micrograms per day should only be prescribed if additional clinical benefits are expected.

Fluticasone Furoate (Dry Powder Inhaler)

Moderate Dose: 100 micrograms once daily.

High Dose: 200 micrograms once daily.

Fluticasone furoate is generally considered equivalent to fluticasone propionate at higher doses, with 100 micrograms of fluticasone furoate being approximately equivalent to 250 micrograms of fluticasone propionate.

Fluticasone Nasal Spray Dosage

For Adults

Initial Dose: 1 or 2 sprays in each nostril twice daily (totaling 186 to 372 micrograms per day depending on the number of sprays).

Maintenance Dose: Typically, 1 spray in each nostril once daily (200 micrograms total).

For Children (Aged 4 years and older)

Recommended Dose: 1 spray in each nostril once daily (100 micrograms total).

What are the side-effects of Fluticasone?

Fluticasone, whether used as an inhaler, nasal spray, or topical treatment, can cause side effects. The specific side effects vary depending on the form of administration.

Common Side Effects (Inhaled Fluticasone):

• Oral Thrush (Candidiasis): A fungal infection in the mouth or throat, characterised by white patches and soreness.
• Hoarseness or Voice Changes: Due to irritation of the vocal cords.
• Cough or Sore Throat: Mild irritation of the throat.
• Headache: A common side effect with many inhaled corticosteroids.
• Nasal Congestion or Runny Nose: Occasionally, users may experience these symptoms.

Common Side Effects (Nasal Spray Fluticasone):

• Nosebleeds (Epistaxis): A frequent side effect due to nasal dryness and irritation.
• Nasal Irritation: Includes itching, burning, or stinging in the nose.
• Headache: A commonly reported side effect.
• Dry or Sore Throat: Particularly after prolonged use.
• Unpleasant Taste or Smell: Some users report an altered sense of taste or smell.

Common Side Effects (Topical Fluticasone):

• Skin Irritation: Includes redness, itching, burning, or dryness at the application site.
• Thinning of the Skin (Skin Atrophy): Prolonged use can lead to thinning and weakening of the skin.
• Stretch Marks (Striae): Can occur with long-term use, especially in areas of skin folds.
• Acne or Folliculitis: Inflammation of hair follicles can develop.

Less Common but Serious Side Effects:

• Suppression of Adrenal Gland Function: Long-term use, especially at high doses, can suppress the adrenal glands' ability to produce cortisol.
• Growth Suppression in Children: Prolonged use of inhaled or topical corticosteroids can slow growth in children.
• Osteoporosis: Long-term use can lead to decreased bone density.
• Cataracts or Glaucoma: Prolonged use of nasal or inhaled forms can increase the risk of these eye conditions.
• Hypersensitivity Reactions: Rash, itching, swelling, or severe dizziness may occur, and in rare cases, anaphylaxis.

Important Considerations:

• Rinse Mouth After Inhaler Use: To prevent oral thrush, users should rinse their mouth after using an inhaler.
• Monitor for Long-Term Effects: Regular check-ups with a healthcare provider are important for those using Fluticasone long-term, especially in children or at high doses.
  

Drug Interactions

1. CYP3A4 Inhibitors:

• Common Drugs: Ritonavir (used in HIV treatment), Ketoconazole (antifungal), Itraconazole (antifungal), Clarithromycin (antibiotic).
• Interaction: These drugs can increase the levels of Fluticasone in the blood by inhibiting the enzyme CYP3A4, which is responsible for metabolising Fluticasone. This can increase the risk of systemic side effects, such as adrenal suppression, Cushing's syndrome, or increased risk of infections.

2. Other Corticosteroids:

• Common Drugs: Prednisone, Methylprednisolone, Dexamethasone (oral or injectable corticosteroids).
• Interaction: Using multiple corticosteroids simultaneously can increase the risk of systemic side effects like weakened immune response, increased blood sugar levels, or suppression of adrenal gland function.

3. Drugs that Weaken the Immune System:

• Common Drugs: Methotrexate, Cyclosporine, Biologic agents (e.g., TNF inhibitors).
• Interaction: Combining Fluticasone with immunosuppressive drugs can further weaken the immune system, increasing the risk of infections.

4. Diuretics (Water Pills):

• Common Drugs: Furosemide, Hydrochlorothiazide.
• Interaction: Combining these with Fluticasone might increase the risk of hypokalemia (low potassium levels), especially in high doses of Fluticasone, as corticosteroids can affect electrolyte balance.

5. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):

• Common Drugs: Ibuprofen, Aspirin, Naproxen.
• Interaction: While there’s no direct interaction, using NSAIDs with Fluticasone (especially orally or inhaled) could potentially increase the risk of gastrointestinal side effects or ulcers, particularly with long-term use.

6. Antidiabetic Medications:

• Common Drugs: Metformin, Insulin, Sulfonylureas.
• Interaction: Corticosteroids like Fluticasone can increase blood sugar levels, potentially requiring adjustments in diabetes medications.

7. Vaccines:

• Interaction: Fluticasone can weaken the immune response, making live vaccines (like the MMR or yellow fever vaccines) less effective or increasing the risk of an adverse reaction. It’s generally recommended to avoid live vaccines during corticosteroid therapy.

Natural Alternatives to Fluticasone ²

Stinging Nettle (Urtica dioica): Known for its painful sting, stinging nettle is an effective herbal remedy for allergic rhinitis, offering antioxidant, astringent, antimicrobial, and analgesic properties that reduce inflammation without pharmaceutical side effects. It can be consumed cooked or as tea. In social media, some people have tried regularly stinging themselves with stinging nettles and many reported positive outcomes, but you should do your own research before you try this. 

Perilla (Perilla frutescens): A member of the mint family, perilla helps alleviate allergic rhinitis symptoms, including nasal congestion, sinusitis, and skin conditions. It also boosts serotonin levels, improving mood and well-being.

Sea Buckthorn (Hippophae rhamnoides): This nutrient-dense shrub is rich in vitamins and phytonutrients, making it ideal for respiratory health, including allergic rhinitis, asthma, and chronic coughs. Its unique nutrient profile also benefits eye, mouth, and mucous membrane health.

Butterbur (Petasites hybridus): Traditionally used for pain and digestive issues, butterbur has shown promise in treating hay fever and migraines, working similarly to allergy medications like Zyrtec. Only use PA-free products to avoid harmful alkaloids.

Ginger (Zingiber officinale): Ginger is a versatile herb that soothes the digestive system, improves circulation, and acts as a natural antihistamine and immune booster. It can be consumed as tea to relieve nasal congestion and headaches.

Yarrow (Achillea millefolium): A perennial herb with antiseptic and anti-inflammatory properties, yarrow is used for treating colds, fevers, and allergic rhinitis. It's effective for respiratory health but should be used cautiously, especially by those allergic to ragweed.

Interesting facts about Fluticasone

Fluticasone is often combined with other medications in single inhalers for asthma, such as the combination with salmeterol (Advair) or vilanterol (Breztri), which helps to improve overall management by providing both anti-inflammatory and bronchodilator effects.

Ongoing research explores its potential benefits in other conditions, such as chronic obstructive pulmonary disease (COPD) and certain autoimmune diseases, highlighting its versatility beyond asthma and allergic rhinitis.

Disclaimer

This article is generated for informational purposes only. It was created in December 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://bnf.nice.org.uk/drugs/fluticasone/
2. https://www.sinusandallergywellnesscenter.com/blog/allergic-rhinitis-6-herbal-remedies-to-try-sinus-allergy-wellness-clinic