What is the typical dosage of fluticasone propionate (FP) for adults and children with asthma, allergic rhinitis, or skin disorders?

Fluticasone Propionate Dosage

For allergic rhinitis in adults, use fluticasone propionate 2 sprays (100 mcg total) per nostril once daily; for children aged 4-11 years, use 1 spray (50 mcg) per nostril once daily. 1

Allergic Rhinitis Dosing

Adults and Adolescents (≥12 years)

• Standard dose: 2 sprays per nostril once daily (200 mcg total daily dose) 1
• Alternative: 2 sprays per nostril twice daily for more severe symptoms 1
• Each spray delivers 50 mcg of fluticasone propionate 1

Children (4-11 years)

• Recommended dose: 1 spray per nostril once daily (100 mcg total daily dose) 1, 2
• This represents half the adult dose and has been shown equally effective as 200 mcg once daily in pediatric studies 2
• FDA-approved for children as young as 4 years 1

Key Clinical Points for Rhinitis

• Once-daily dosing is as effective as twice-daily dosing for both fluticasone propionate and comparison agents like beclomethasone 3
• Morning administration is preferred for once-daily regimens 3
• Common side effects include headache, pharyngitis, epistaxis, and nasal burning 1

Asthma Dosing (Inhaled Formulations)

Adults and Adolescents (≥12 years)

The American Academy of Family Physicians recommends a stepwise approach: 4

• Low dose (Step 2): 100 mcg twice daily (200 mcg total daily) 4
• Medium dose (Step 3-4): 250 mcg twice daily (500 mcg total daily) 4
• High dose (Step 5-6): 500 mcg twice daily (1000 mcg total daily) 5, 4

Maximum recommended dose: 500 mcg twice daily (1000 mcg total daily dose) to minimize systemic side effects including adrenal suppression and bone loss 5

Children (5-11 years)

For moderate asthma severity: 4

• Low dose: 100-200 mcg total daily 4
• Medium dose: >200-500 mcg total daily (typically 100-250 mcg twice daily) 4
• High dose: >500 mcg total daily 4

A long-term study demonstrated that 200 mcg twice daily offers benefits over 100 mcg twice daily, particularly in children with more severe asthma (previously requiring >800 mcg/day of other inhaled corticosteroids) 6

Children (4-11 years) - Specific Considerations

• Moderate persistent asthma: Fluticasone propionate >176-352 mcg per day (HFA/MDI) or >200-500 mcg per day (DPI) 4
• This translates to approximately 2-4 puffs of 110 mcg strength twice daily, or 1-2 puffs of 220 mcg strength twice daily 4

Young Children (<4 years)

• Budesonide inhalation suspension is preferred as it is the only FDA-approved inhaled corticosteroid for this age group 7
• Children under 4 years cannot use metered-dose inhalers or dry powder inhalers effectively due to insufficient inspiratory flow 7

Administration Technique

For Nasal Spray

• Shake bottle before each use 3
• Prime pump if not used for several days 1
• Avoid spraying directly at nasal septum to reduce epistaxis risk 1

For Inhaled Formulations

• Use a spacer or valved holding chamber with MDIs to enhance lung deposition and reduce local side effects 4
• Rinse mouth and spit after each use to prevent oral thrush (candidiasis) 4
• For young children requiring MDI, use a face mask that fits snugly over nose and mouth 7

Safety Considerations

Systemic Effects

• Doses >1000 mcg/day are associated with increased risk of bone loss, adrenal suppression, osteoporosis, skin thinning, and bruising 5
• At therapeutic doses (≤1000 mcg/day), systemic bioavailability is minimal (<1% oral absorption) due to extensive first-pass metabolism 8, 9
• Growth velocity suppression has been observed in children on inhaled corticosteroids, though this effect may be transient and small (approximately 1 cm) 5, 4

Monitoring

• Reassess asthma control every 2-6 weeks initially when starting or adjusting therapy 4
• Titrate to minimum effective dose once control is achieved 4
• Monitor for local effects: cough, dysphonia, oral candidiasis 5, 4
• At moderate-to-high doses, consider monitoring growth velocity in children 5, 4

Common Pitfalls to Avoid

• Do not use long-acting beta agonists as monotherapy - always combine with inhaled corticosteroids in asthma management 4
• Combination therapy (ICS + LABA) is preferred over doubling ICS dose for uncontrolled moderate-to-severe asthma 4
• Do not discontinue therapy abruptly as this may lead to asthma exacerbation 7
• For rhinitis, once-daily dosing is sufficient for most patients; twice-daily dosing does not provide additional benefit 3