What is the dosage and use of Fluticasone?

Fluticasone Dosage and Use Guidelines

Fluticasone is available in different formulations with specific dosing regimens depending on the condition being treated, with nasal spray starting at 100-200 mcg daily for allergic rhinitis and inhaled formulations at 88-264 mcg daily for asthma. 1, 2

Nasal Spray (Fluticasone Propionate) for Allergic Rhinitis

Adult Dosing

• Starting dose: 2 sprays (50 mcg per spray) in each nostril once daily (total: 200 mcg/day) 1
• Alternative dosing: 1 spray in each nostril twice daily (total: 200 mcg/day) 1
• Maintenance dose: May reduce to 1 spray in each nostril once daily (100 mcg/day) after initial symptom control 1
• As-needed use: Some patients (≥12 years) with seasonal allergic rhinitis may use 200 mcg once daily as needed 3

Children and Adolescents (4-11 years)

• Starting dose: 1 spray in each nostril once daily (100 mcg/day) 1
• For inadequate response: May increase to 2 sprays in each nostril once daily (200 mcg/day) 1
• Maximum dose: Should not exceed 200 mcg/day 1, 4

Administration Technique

• Tilt head slightly forward
• Direct spray away from nasal septum
• Rinse mouth after use to prevent local side effects 2

Inhaled Fluticasone for Asthma

Dosage Categories by Age

• Children 4-11 years:

  • Low dose: 88-176 mcg/day
  • Medium dose: 176-352 mcg/day
  • High dose: >352 mcg/day 2

• Adolescents ≥12 years and Adults:

  • Low dose: 88-264 mcg/day
  • Medium dose: 264-440 mcg/day
  • High dose: >440 mcg/day 2

Administration Technique

• Use metered-dose inhaler (MDI) with spacer or valved holding chamber
• For children <4 years: Use face mask with spacer
• Take 5-6 breaths per actuation
• Rinse mouth after use to prevent oral thrush 2

Fluticasone for Eosinophilic Esophagitis

• Adults: 880-1760 mcg/day, divided into 2-4 doses 3
• Children: 440-880 mcg/day, divided into 2 doses 3
• Administration: Spray MDI in mouth with lips sealed around device, swallow (do not rinse), and avoid eating/drinking for 30 minutes 3

Efficacy and Benefits

• Intranasal fluticasone is the most effective medication for treating allergic rhinitis, superior to the combination of antihistamine and leukotriene antagonist 3
• Once-daily dosing is as effective as twice-daily dosing of the same total dose 2, 5
• Onset of action occurs between 3-12 hours after administration 3
• For asthma, fluticasone shows clinical efficacy at half the dose of other corticosteroids like beclomethasone or budesonide 6

Side Effects and Monitoring

Local Side Effects

• Nasal spray: Nasal irritation, epistaxis (rare), nasal septal perforation (rare) 3
• Inhaled: Cough, dysphonia, oral thrush (candidiasis) 2

Systemic Effects

• At recommended doses, fluticasone has minimal systemic effects 6
• No consistent clinically relevant effects on hypothalamic-pituitary-adrenal axis at standard doses 3
• No significant effects on ocular pressure, cataract formation, or bone density at recommended doses 3
• Growth effects in children are dose-dependent; studies with fluticasone have shown no effect on growth at recommended doses 3

Special Considerations

• Not recommended for children under 4 years of age 1
• For combination therapy in allergic rhinitis, intranasal fluticasone with an oral antihistamine provides better symptom control 2
• In patients with both asthma and allergic rhinitis, fluticasone nasal spray provides superior rhinitis control compared to montelukast 7
• Proper technique and regular use at scheduled intervals provide optimal effect 1

Monitoring Recommendations

• Assess efficacy within 4-6 weeks of starting treatment
• Consider step-down therapy once adequate control is maintained for at least 3 months
• Monitor for local side effects and periodically examine the nasal cavity when using nasal spray 3
• Monitor growth in pediatric patients on long-term therapy 2