Drug Guide
Fluticasone Furoate
Classification
Therapeutic: Allergic rhinitis, Asthma
Pharmacological: Inhaled corticosteroid
FDA Approved Indications
- Relief of symptoms of allergic rhinitis (nasal congestion, sneezing, rhinorrhea, nasal itching)
- Maintenance treatment of asthma in adults and adolescents
Mechanism of Action
Fluticasone Furoate is a corticosteroid that exerts anti-inflammatory effects by inhibiting multiple types of inflammatory cells, decreasing edema of nasal mucosa, and reducing the release of mediators involved in allergic reactions.
Dosage and Administration
Adult: For allergic rhinitis: 2 sprays in each nostril once daily. For asthma: 100 mcg once daily for adults.
Pediatric: For asthma: 100 mcg once daily in adolescents aged 12 and over.
Geriatric: Dose adjustments are generally not necessary but should be individualized based on response.
Renal Impairment: No specific adjustments needed.
Hepatic Impairment: No specific adjustments recommended.
Pharmacokinetics
Absorption: Minimal nasal absorption; systemic absorption occurs and varies based on dose.
Distribution: Wide distribution after absorption; protein binding is approximately 90%.
Metabolism: Primarily hepatic via CYP3A4.
Excretion: Metabolites are excreted mainly in urine and feces.
Half Life: Approximately 15 hours.
Contraindications
- Hypersensitivity to fluticasone or any component of the formulation.
Precautions
- Use with caution in patients with active or untreated infections of the nasal mucosa. Avoid contact with eyes to prevent glaucoma or cataracts.
- Use during active infection of the nasal mucosa should be cautious.
Adverse Reactions - Common
- Headache (Common)
- Nasal irritation or burning (Common)
- Pharyngeal pain (Common)
- Cough (Common)
Adverse Reactions - Serious
- Glaucoma or cataracts (Rare)
- Systemic corticosteroid effects (adrenal suppression, osteoporosis, etc.) (Rare)
Drug-Drug Interactions
- Concomitant use with CYP3A4 inhibitors (e.g., ketoconazole) may increase systemic corticosteroid risk.
Drug-Food Interactions
- None significant
Drug-Herb Interactions
- None well-established
Nursing Implications
Assessment: Monitor nasal symptoms and control of asthma. Assess for signs of systemic corticosteroid effects.
Diagnoses:
- Risk for infection
- Ineffective airway clearance
Implementation: Administer as prescribed. Educate patient on proper nasal spray technique.
Evaluation: Symptom relief, minimal adverse effects, and no signs of systemic corticosteroid effects.
Patient/Family Teaching
- Use nasal spray as directed, do not exceed prescribed dose.
- Report any signs of nasal irritation, vision changes, or mood changes.
- Do not stop medication abruptly.
- Use regularly for best results.
Special Considerations
Black Box Warnings:
- Oral corticosteroids may cause significant side effects; inhaled forms have lower risk but systemic absorption can occur.
Genetic Factors: No specific genetic considerations.
Lab Test Interference: None significant.
Overdose Management
Signs/Symptoms: Potential systemic corticosteroid effects such as adrenal suppression, hyperglycemia, or Cushingoid features if taken in excess.
Treatment: Supportive care; consider corticosteroid tapering if systemic effects are evident.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable until expiration date on packaging.