Is fluticasone propionate (FP) 110 similar to Pulmicort (budesonide)?

Fluticasone Propionate 110 mcg vs Pulmicort (Budesonide): Comparison

Fluticasone propionate 110 mcg is approximately equivalent to budesonide 200-220 mcg based on established dosing guidelines, making them similar but not identical in potency—fluticasone is roughly 1.5-2 times more potent per microgram than budesonide. 1

Dose Equivalency Based on Guidelines

The EPR-3 asthma guidelines provide clear dose equivalency tables that establish the relationship between these medications 1:

For adults:

• Fluticasone propionate (HFA/MDI) 110 mcg/puff: Low daily dose is 88-264 mcg
• Budesonide (DPI) 90,180, or 200 mcg/inhalation: Low daily dose is 180-600 mcg

This translates to fluticasone 110 mcg being roughly comparable to budesonide 180-220 mcg in clinical practice 1.

For children (5-11 years):

• Fluticasone 88-176 mcg daily (low dose) corresponds to budesonide 180-400 mcg daily (low dose) 1

Potency Ratio Evidence

Clinical Trial Data

The DICE study established a rank order of systemic potency based on HPA axis suppression, showing that fluticasone propionate delivered by DPI had a potency ratio of 2.08:1 compared to reference, while budesonide DPI was 3.45:1 1. This suggests fluticasone has greater systemic effects at equivalent labeled doses.

Direct comparison research demonstrates:

• The potency ratio of fluticasone propionate (Flixotide Diskus) to budesonide (Pulmicort Turbuhaler) is 1.50:1 to 1.75:1 (95% CI 1.10:1-2.43:1) 2
• This potency difference is most evident at low daily doses below 200 mcg 2

Efficacy Comparisons

Multiple Cochrane meta-analyses comparing fluticasone to budesonide at a 1:2 dose ratio (half the dose of fluticasone) found 3, 4, 5:

• FEV1 improvement: Fluticasone at half the dose produced significantly greater improvements (0.11-0.14 liters, 95% CI 0.01-0.22 liters) 3, 4
• Morning PEF: Fluticasone showed 11-13 L/min greater improvement (95% CI 3-22 L/min) 3, 4, 5
• Evening PEF: Fluticasone demonstrated 9-11 L/min greater improvement (95% CI 1-20 L/min) 3, 4, 5

A pooled meta-analysis of 1,980 patients confirmed fluticasone at half the microgram dose was more effective than budesonide, with an overall PEFR difference of +11 L/min 6.

Safety Profile Differences

Systemic effects at equivalent doses:

• When fluticasone is given at half the dose of budesonide, there is greater likelihood of pharyngitis (Peto OR 2.16,95% CI 1.43-3.24) 3, 4
• No significant difference in oral candidiasis rates between the two medications 3, 4, 5
• At low doses, no differences in serum cortisol suppression, but at higher doses, fluticasone shows less cortisol suppression than budesonide 6

Clinical Application

For practical prescribing:

• Fluticasone propionate 110 mcg twice daily (220 mcg/day total) is clinically similar to budesonide 200 mcg twice daily (400 mcg/day total) 1
• The preparations are not interchangeable on a mcg-per-puff basis and require dose adjustment when switching 1
• Both medications require proper inhaler technique and consideration of delivery device characteristics 1

Important caveats:

• Both fluticasone and budesonide are metabolized by CYP3A4 enzymes, requiring caution with potent inhibitors like ritonavir or ketoconazole 1
• Local side effects (cough, dysphonia, oral thrush) can be minimized with spacer devices and mouth rinsing after use 1
• The clinician must monitor patient response and titrate to the minimum effective dose once control is achieved 1