Fluticasone: English spelling of the glucocorticoid Fluticason
Fluticasone is the English spelling of the highly potent synthetic glucocorticoid Fluticason. It appears in English language literature and in many brand names (Flixotide, Avamys, Flonase, Cutivate). In Germany the spelling Fluticason is used. Pharmacologically it is the same substance, used in two ester forms (fluticasone propionate and fluticasone furoate).
Fluticasone is one of the most widely prescribed inhaled and topical glucocorticoids. It combines high receptor affinity with low systemic bioavailability, allowing strong local effect with reduced systemic effects. It is used in bronchial asthma, COPD, allergic rhinitis, atopic dermatitis and, since 2024, also in eosinophilic oesophagitis (although Jorveza there is budesonide).
Mechanism of action
Fluticasone binds with high affinity to the intracellular glucocorticoid receptor. The hormone receptor complex moves into the nucleus and regulates the transcription of numerous genes. The most important clinically relevant effects are:
- Inhibition of phospholipase A2 with reduced synthesis of prostaglandins, leukotrienes and platelet activating factor
- Reduction of cytokine release from T cells, mast cells and eosinophils
- Inhibition of inflammatory cell migration into tissue
- Stabilisation of vascular permeability
- Increased sensitivity of bronchial muscle to beta 2 agonists
The high local effect with low systemic bioavailability (about 1 % after inhalation) is based on strong hepatic first pass metabolism via CYP3A4 and rapid clearance.
Indications
- Bronchial asthma: inhaled as monotherapy (Flixotide) or in fixed combinations with salmeterol (Seretide), vilanterol (Relvar Ellipta) or in triple therapies
- Chronic obstructive pulmonary disease (COPD): in patients with frequent exacerbations or asthma COPD overlap, in combination products
- Allergic rhinitis: nasal spray (Avamys, Flonase) for seasonal and perennial forms
- Atopic dermatitis and other inflammatory skin diseases: topical cream or ointment (Cutivate)
- Nasal polyps: nasally with good efficacy
Dosing and administration
Asthma inhaled in adults: 100 to 1,000 µg per day depending on severity. Split into two doses, possibly once daily at low doses.
COPD inhaled: 500 µg twice daily or as part of modern triple therapies.
Allergic rhinitis nasal: 1 spray in each nostril once daily (fluticasone furoate 27.5 µg).
Topical adults: Cutivate cream 0.05 % or ointment 0.005 %, once or twice daily on affected skin, as thinly as possible.
Correct technique is decisive with inhalation. Rinsing the mouth with water reduces the risk of oral candidiasis and hoarseness.
Adverse effects
Inhaled common: hoarseness, oral thrush (oral candidiasis), cough, airway irritation, headache.
Nasal common: nosebleed, irritation of nasal mucosa, sore throat.
Topical common: skin atrophy with longer use, telangiectasia, perioral dermatitis, striae.
Systemic (with high inhaled doses or long term use): Cushing like symptoms, growth retardation in children, osteoporosis, cataract, glaucoma, adrenal insufficiency after abrupt withdrawal.
Important points:
- Rinse the mouth after inhalation to avoid oral thrush
- Monitor growth in children
- Use topically with caution on the face and in skin folds
- Monitor bone density and ocular status with long term high dose inhalation
Interactions
- Strong CYP3A4 inhibitors (itraconazole, ketoconazole, ritonavir, erythromycin): marked level rise with risk of systemic steroid effects, avoid the combination if possible
- Beta adrenergics (LABA, SABA): sensible combination for bronchodilation
- Other glucocorticoids: additive systemic effect
- Antidiabetics: hyperglycaemia possible at systemically active doses
Special considerations
Pregnancy: may be used with clear indication. Asthma therapy experience shows no increased malformation risk.
Breastfeeding: small amounts pass into milk, generally clinically harmless.
Children: inhaled and nasal use established, regular growth checks recommended.
Inhalation technique: regular review of technique. A spacer for metered dose inhalers improves lung deposition and reduces oropharyngeal effects.
End of therapy: taper slowly after long term high dose therapy to avoid adrenal insufficiency.
Patient communication: realistic information about the importance of consistent daily use as basic therapy. Inhaled steroids do not work acutely and must be used regularly even when no acute symptoms are present.
Related substances
- Fluticason, German spelling of the same substance
- Betamethasone, highly potent glucocorticoid
- Aclidinium, LAMA in COPD
- Umeclidinium, LAMA in Trelegy triple therapy
- Montelukast, leukotriene antagonist in asthma
Frequently asked questions
Fluticasone or Fluticason?
English fluticasone, German Fluticason. Identical substance in two ester forms (propionate, furoate) for different galenical applications.
Why rinse the mouth after inhalation?
Small amounts of drug remain in the mouth and throat. Rinsing with water or spitting after gargling clearly reduces the risk of oral candidiasis and hoarseness. In children a sip of water also helps.
Does inhaled fluticasone slow growth?
In children a small and usually transient growth deceleration has been observed under inhaled steroid therapy. Long term studies show that final adult height is practically unaffected when the dose is appropriate. Regular growth checks are sensible.
Can I stop the inhaler when I feel well?
Inhaled steroids are basic therapy. Without consistent use exacerbations rise and disease activity increases over the long term. Any therapy adjustment or trial stop should always be agreed with the treating doctor.
Sources
- EMA European Medicines Agency
- BfArM German Federal Institute for Drugs and Medical Devices
- AWMF NVL asthma and COPD
- Gelbe Liste fluticasone monograph
Legal notice and disclaimer
The information on this page is provided for general information only and does not constitute medical advice, diagnosis or treatment recommendation. It does not replace advice from a qualified physician or pharmacist. Medicines should only be used on prescription or after dispensing by a pharmacist. All information is based on the product information available at the time of writing and on recognised scientific sources; the manufacturer's current product information always prevails. Sanoliste assumes no liability for completeness, timeliness or accuracy of the information presented. In a medical emergency call the European emergency number 112.