What is the recommended dosage of FLOVENT (fluticasone propionate) inhaler for a patient with asthma or Chronic Obstructive Pulmonary Disease (COPD)?

FLOVENT Inhaler Dosage for Asthma

For asthma management, FLOVENT (fluticasone propionate) should be dosed twice daily, not once daily, with specific dosages based on age and disease severity ranging from 88-264 mcg twice daily for low-dose therapy up to >440 mcg twice daily for high-dose therapy in adults. 1

Dosing by Age and Severity

Adults and Adolescents (≥12 years)

Low-dose therapy: 88-264 mcg/day total

• HFA/MDI: 88-264 mcg divided twice daily 1
• DPI: 100-400 mcg divided twice daily 1

Medium-dose therapy: >264-440 mcg/day total

• HFA/MDI: >264-440 mcg divided twice daily 1
• DPI: 300-400 mcg divided twice daily 1

High-dose therapy: >440 mcg/day total

• HFA/MDI: >440 mcg divided twice daily 1
• DPI: >500 mcg divided twice daily 1

Children (5-11 years)

Low-dose: 88-176 mcg twice daily (HFA/MDI) or 200-300 mcg divided doses (DPI) 1

Medium-dose: >176-352 mcg twice daily (HFA/MDI) or >200-500 mcg divided doses (DPI) 1

High-dose: >352 mcg twice daily (HFA/MDI) or >400 mcg divided doses (DPI) 1

Young Children (0-4 years)

Low-dose: 176 mcg/day divided twice daily 1

Medium-dose: >176-352 mcg/day divided twice daily 1

High-dose: >352 mcg/day divided twice daily 1

Critical Dosing Principles

Twice-daily administration is mandatory for optimal efficacy. Once-daily dosing of fluticasone propionate has been shown to be statistically indistinguishable from placebo in most studies, with twice-daily dosing providing significantly greater improvements in FEV₁ (mean difference 0.11 L), peak expiratory flow (mean difference 12.9 L/min), and fewer withdrawals due to asthma exacerbations. 2, 3

Dose titration strategy: Start at the appropriate dose for asthma severity, monitor clinical response on multiple parameters (lung function, symptoms, exacerbations, beta-agonist use), and once control is achieved, carefully titrate to the minimum dose required to maintain control. 1

Important Clinical Considerations

Device-specific delivery: Different formulations (HFA/MDI vs DPI) are not interchangeable on a mcg-per-puff basis, requiring attention to the specific device being prescribed. 1

For children <4 years: Delivery requires a face mask that fits snugly over nose and mouth; the face should be washed after each treatment to prevent local side effects. 1

Spacer use: For high doses of inhaled corticosteroids (≥1,000 mcg/day), use a large-volume spacer or dry-powder system to optimize delivery and reduce local side effects. 1

Local side effects prevention: Use spacer or valved holding chamber with non-breath-actuated MDIs, and perform mouthwashing and spitting after inhalation to decrease risk of cough, dysphonia, and oral candidiasis. 1

COPD Consideration

FLOVENT is NOT indicated as monotherapy for COPD. The European Respiratory Society guidelines note that inhaled corticosteroids in COPD should only be considered for patients with fast rate of FEV₁ decline (>50 mL/year) and should be used in combination with bronchodilators, not as standalone therapy. 1

Common Pitfalls to Avoid

• Never prescribe once-daily dosing expecting equivalent efficacy to twice-daily administration 2, 3
• Do not assume dose equivalence between different fluticasone formulations or between fluticasone and other inhaled corticosteroids 1
• Avoid prescribing without clear instructions on proper inhaler technique, as delivery method significantly impacts efficacy 1
• Do not continue high doses indefinitely without attempting dose reduction once asthma control is achieved 1