Fluticasone Dosing Recommendations
The recommended dosing for fluticasone varies by formulation, age, and indication, with nasal spray typically dosed at 100-200 mcg daily for adults and 100 mcg daily for children, while inhaled fluticasone for asthma is most effective at relatively low doses (88-264 mcg/day) with minimal additional benefit at higher doses. 1
Nasal Fluticasone Dosing
Adults and Adolescents (≥12 years)
- Starting dose: 2 sprays (50 mcg per spray) in each nostril once daily (200 mcg total daily dose) 2
- Alternative dosing: 1 spray in each nostril twice daily (200 mcg total) is equally effective 2
- Maintenance dose: May reduce to 1 spray in each nostril once daily (100 mcg total) after initial symptom control 2
- Once-daily dosing is as effective as twice-daily dosing of the same total dose 3, 4
Children (4-11 years)
- Recommended dose: 1 spray (50 mcg) in each nostril once daily (100 mcg total) 1, 2
- May increase to 2 sprays in each nostril once daily (200 mcg total) if inadequate response 2
- Once adequate control is achieved, decrease to 1 spray in each nostril daily 2
- Maximum dose: Should not exceed 200 mcg/day 2, 5
Children (<4 years)
- Not recommended for children under 4 years of age 2
Inhaled Fluticasone for Asthma
Adults and Adolescents (≥12 years)
- Low dose: 88-264 mcg/day 1
- Medium dose: 264-440 mcg/day 1
- High dose: >440 mcg/day 1
- Greatest clinical benefit is often observed at relatively low doses (200 μg/day) 1, 6
Children (4-11 years)
- Low dose: 88-176 mcg/day 1
- Medium dose: 176-352 mcg/day 1
- High dose: >352 mcg/day 1
- Maximum recommended dose for severe asthma: 200 mcg daily 1
Children (<4 years)
- Budesonide inhalation suspension is preferred for this age group (0.25-0.5 mg once daily or divided twice daily) 1
Administration Techniques
Nasal Spray
- Tilt head slightly forward
- Direct spray away from nasal septum 1
- Follow illustrated instructions provided with each package 2
Inhaled Fluticasone
- Use a spacer or valved holding chamber, especially for children
- Rinse mouth after inhalation to prevent local side effects (thrush, dysphonia) 1
- Children <4 years generally require delivery through a face mask 1
Monitoring and Adjustment
- Assess efficacy within 4-6 weeks of starting treatment 1
- Consider step-down therapy once adequate control is maintained for at least 3 months 1
- Monitor growth in pediatric patients 1
- For asthma, consider alternative therapies if clear benefit not observed 1
Safety Considerations
- Common side effects: Cough, dysphonia, oral thrush 1
- Risk of oropharyngeal candidiasis increases with higher doses 1
- High doses (>500 mcg/day) for extended periods may affect:
- Cases of adrenal insufficiency reported in children receiving 500-2000 mcg daily for extended periods 7
- For patients on high doses (>500 mcg/day) for >6 months undergoing surgery or with infection, consider preventive treatment for adrenal insufficiency 7
Dosing Pitfalls to Avoid
- Avoid excessive dosing: Higher doses provide minimal additional benefit but increase risk of side effects 1, 7, 6
- Don't use LABA monotherapy: Long-acting beta agonists should never be used without inhaled corticosteroids 1
- Don't undertreat initially: Twice daily dosing is more effective for initiating maintenance therapy than once daily 7
- Don't expect quicker control with excessive doses: High off-label dosing does not allow faster asthma control 7