Learning Center/Pharmacology/Fluticasone Propionate

Fluticasone Propionate

Flovent / Flonase / Advair (with salmeterol) / Breo (with vilanterol)

corticosteroid inhaledinhaled (MDI — HFA) · inhaled (DPI — Diskus) · nasal sprayOnset: 12–24 hours (anti-inflammatory); maximum effect 1–2 weeksDuration: Sustained with regular use

Mechanism of Action

High-potency synthetic glucocorticoid. High receptor binding affinity (approximately 3× beclomethasone). Reduces airway inflammation via glucocorticoid receptor-mediated gene regulation.

Dosing

Adult

Flovent HFA MDI: 88–440 mcg BID. Flovent Diskus DPI: 100–500 mcg BID

Pediatric

≥4 years: 88 mcg BID (low dose); titrate up

Indications

Asthma maintenance (all severity)
COPD with frequent exacerbations (adjunct)
Allergic rhinitis (nasal formulation)

Contraindications

Acute bronchospasm
Status asthmaticus as sole therapy
Hypersensitivity to fluticasone

Side Effects

Oropharyngeal candidiasis
Dysphonia
Upper respiratory infection
Adrenal suppression (high doses)
Bone mineral density loss
Pneumonia risk in COPD patients (higher with fluticasone vs. budesonide)

Monitoring Parameters

Oral cavity (candidiasis)
Growth velocity in pediatric patients
Bone density with long-term high-dose use
HPA axis suppression
Pneumonia symptoms in COPD patients

Drug Interactions

Strong CYP3A4 inhibitors (ritonavir — significant fluticasone accumulation)
Systemic corticosteroids (additive HPA suppression)

Clinical Pearls

Rinse mouth after every dose
High potency — start at lowest effective dose
Advair (fluticasone/salmeterol) is one of the most prescribed asthma inhalers
COPD: associated with higher pneumonia risk compared to budesonide
Ritonavir interaction can cause Cushing syndrome — clinically important in HIV patients

Mnemonic

💡 Fluticasone = Flu-ticasone: prevents 'flare-ups' not 'flu' — long-term control

NBRC High-Yield

High-potency ICS — rinse mouth after use
Advair = fluticasone + salmeterol (most common ICS/LABA combo)
Higher pneumonia risk in COPD vs. budesonide
Ritonavir dramatically increases fluticasone levels → adrenal suppression
Not for acute bronchospasm

← All Drugs

Clinical Pearls

Rinse mouth after every dose

High potency — start at lowest effective dose

Advair (fluticasone/salmeterol) is one of the most prescribed asthma inhalers

COPD: associated with higher pneumonia risk compared to budesonide

Ritonavir interaction can cause Cushing syndrome — clinically important in HIV patients