What is the dose of fluticasone (corticosteroid)?

Fluticasone Dosing

The dose of fluticasone depends on the indication, formulation, and patient age, with inhaled corticosteroid doses for asthma ranging from 88-880 mcg/day in adults (divided twice daily), intranasal doses of 100-200 mcg/day for allergic rhinitis, and swallowed topical doses of 880-1760 mcg/day for eosinophilic esophagitis. 1, 2

Asthma (Inhaled Corticosteroid)

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
• Maximum recommended: 500 mcg twice daily (1000 mcg total daily dose) 3, 4
• Doses should be divided twice daily for optimal efficacy 5

Children (5-11 years)

• Low dose: 88-176 mcg/day 1
• Medium dose: >176-352 mcg/day 1
• High dose: >352 mcg/day 1

Children (0-4 years)

• Low dose: 176 mcg/day 1
• Medium dose: >176-352 mcg/day 1
• High dose: >352 mcg/day 1
• Delivery requires face mask with proper fit 1

Key Dosing Principles for Asthma

• Twice-daily dosing is superior to once-daily: Meta-analysis shows significantly better FEV1 (0.11 L improvement) and peak flow (12.9 L/min improvement) with twice-daily administration 5
• Dose-response is relatively flat above low doses: Patients with mild-moderate asthma achieve similar control on 200 mcg/day as on 500+ mcg/day 6
• Titrate to minimum effective dose once control is achieved to minimize systemic effects 1, 4

Allergic Rhinitis (Intranasal)

Adults

• Starting dose: 200 mcg/day (2 sprays per nostril once daily) 2
• Alternative: 100 mcg twice daily (divided dosing) 2
• Maintenance: 100 mcg/day (1 spray per nostril once daily) after initial control 2

Children (≥4 years)

• Starting dose: 100 mcg/day (1 spray per nostril once daily) 2, 7
• Maximum: 200 mcg/day if inadequate response 2
• Maintenance: Decrease to 100 mcg/day once control achieved 2
• The 100 mcg/day dose is as effective as 200 mcg/day in children 7

Efficacy Notes

• All doses (25-400 mcg twice daily) are significantly better than placebo 8
• Symptom improvement evident within 3 days 8
• No HPA axis suppression at recommended doses in children 7

Eosinophilic Esophagitis (Swallowed Topical)

Adults

• Standard dose: 880 mcg twice daily (4 puffs from MDI) 1
• Histological response achieved in 62% vs 0% placebo 1
• Orodispersible budesonide is preferred over fluticasone for regulatory approval, but fluticasone remains effective 1

Children

• Dose: 220-440 mcg twice daily for 6-12 weeks 1
• Clinical and histologic improvement in 31 of 33 patients 1

Administration Technique

• Spray MDI in mouth with lips sealed around device 1
• Do not eat, drink, or rinse for 30 minutes after administration 1
• Alternative: viscous preparation for easier delivery 1

Safety Considerations

Systemic Effects at High Doses

• Doses >1000 mcg/day increase risk of bone loss, adrenal suppression, osteoporosis, and skin thinning 3
• Growth suppression possible in children, though may be transient 3
• Fluticasone >750 mcg/day may lead to bone loss 1

Local Effects

• Oral candidiasis occurs in ≤8% at doses ≤250 mcg twice daily 9
• Hoarseness and dysphonia are common 1, 3
• Use spacer device and rinse mouth after inhalation to reduce local effects 1, 3, 4

Monitoring

• No clinically significant HPA axis suppression at doses ≤500 mcg/day 9
• Routine monitoring not required at standard doses 7, 8