Fluticasone Contraindications
Fluticasone is contraindicated only in patients with hypersensitivity to fluticasone or any component of its formulation. 1
Primary Contraindication
- Hypersensitivity reactions: The sole absolute contraindication listed in the FDA drug label is known hypersensitivity to fluticasone propionate or any ingredient in the formulation 1
Special Populations Requiring Caution (Not Absolute Contraindications)
While not formally contraindicated, fluticasone requires careful consideration or avoidance in specific clinical scenarios:
Pregnancy
- Streptomycin (a different medication) is explicitly contraindicated in pregnancy due to fetal hearing loss risk, but fluticasone does not carry this same absolute contraindication 2
- However, systemic corticosteroid exposure during pregnancy warrants careful risk-benefit assessment, particularly with higher doses that may have systemic absorption 2
Active Infections
- Untreated local nasal infections, tuberculosis, or systemic fungal infections require treatment before initiating intranasal corticosteroids, though these represent precautions rather than absolute contraindications 2
Pediatric Considerations
- Fluticasone is FDA-approved for children as young as 4 years of age 3
- Growth velocity suppression has been observed with inhaled corticosteroids in children, though this effect is typically transient and small (approximately 1 cm) 4, 3
- This represents a monitoring consideration rather than a contraindication 4
Common Pitfalls to Avoid
- Do not confuse precautions with contraindications: Many clinicians inappropriately withhold fluticasone in patients with conditions that merely require monitoring (such as glaucoma, cataracts, or osteoporosis risk) rather than representing true contraindications 2
- Local side effects are not contraindications: Epistaxis, nasal irritation, and pharyngitis are common side effects but do not preclude use 3, 5
- Systemic absorption at recommended intranasal doses is minimal: At standard dosing (200 mcg once daily intranasally), systemic cardiovascular or metabolic effects are negligible 6