Generic Name

Fluticasone Propionate

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Classification

FDA Approved Indications

• Allergic rhinitis (nasal)
• Asthma (inhaled)

Mechanism of Action

Fluticasone propionate exerts its anti-inflammatory effects by activating glucocorticoid receptors, leading to inhibition of multiple inflammatory cytokines, thereby reducing airway inflammation and allergy symptoms.

Dosage and Administration

Adult: Dose varies by formulation and condition; for example, intranasal dose for allergic rhinitis usually 1-2 sprays per nostril once daily.

Pediatric: Similar dosing as adults, adjusted by age and condition; e.g., 2 sprays per nostril once daily for allergic rhinitis in children 4 years and older.

Geriatric: No specific dose adjustments, monitor for increased adverse reactions.

Renal Impairment: No specific adjustments; primarily hepatic metabolism.

Hepatic Impairment: No specific adjustments; monitor for altered pharmacokinetics.

Pharmacokinetics

Absorption: Low systemic absorption from nasal tissues and lungs.

Distribution: Wide distribution; binds extensively to plasma proteins.

Metabolism: Primarily metabolized in the liver via CYP3A4.

Excretion: Metabolites excreted mainly in urine.

Half Life: Approximately 7.8 hours for systemic circulation.

Contraindications

• Hypersensitivity to fluticasone or any component of the formulation

Precautions

• Use with caution in patients with: active infections (e.g., tuberculosis), nasal ulcers, or recent nasal surgery. Monitor for adrenal suppression with high doses over prolonged periods. Use during pregnancy and lactation only if benefit > risk.

Adverse Reactions - Common

• Nasal irritation, sneezing, cough (Common)
• Headache (Common)
• Throat irritation (Common)

Adverse Reactions - Serious

• Adrenal suppression (Rare)
• Oral candidiasis (thrush) (Uncommon in inhaler users)
• Severe allergic reactions including anaphylaxis (Rare)

Drug-Drug Interactions

• CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase fluticasone levels.
• Other corticosteroids may have additive effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Use the medication exactly as prescribed.
• Rinse mouth after inhalation to prevent oral thrush.
• Report any signs of infection or adverse reactions.
• Do not stop medication abruptly.

Special Considerations

Black Box Warnings:

• Potential for systemic corticosteroid effects if used in high doses or over long periods.

Genetic Factors: Genetic variations in CYP3A4 may affect metabolism.

Lab Test Interference: May alter certain laboratory tests, e.g., adrenal function tests.

Overdose Management

Signs/Symptoms: Symptoms of overdose are rare but may include signs of systemic corticosteroid excess such as hyperglycemia or adrenal suppression.

Treatment: Discontinue medication and provide symptomatic and supportive care; corticosteroid replacement therapy if needed.

Storage and Handling

Storage: Store at room temperature away from moisture and light.

Stability: Stable for the duration of its shelf life as indicated by the manufacturer.