fluticasone furoate

fluticasone furoate

Veramyst

Pharmacologic class: Corticosteroid

Therapeutic class: Respiratory inhalant (Flovent, Flonase), anti-inflammatory drug (Cutivate)

Pregnancy risk category C

Action

Unknown. Has potent vasoconstrictive and anti-inflammatory properties.

Availability

fluticasone propionate

Inhalation aerosol (Flovent): 44 mcg, 110 mcg, 220 mcg

Nasal spray (Flonase): 50 mcg

Topical cream (Cutivate): 0.005%

Topical ointment (Cutivate): 0.005%

fluticasone furoate

Nasal spray (Veramyst): 27.5 mcg fluticasone furoate in each 50-microliter spray in 10-g bottle containing 120 sprays

⊘Indications and dosages

➣ Prophylaxis of asthma (Flovent)

Adults and children ages 12 and older: Initial dosage is based on previous therapy (see chart below). Once stability is achieved, titrate to lowest effective dosage.

Recommended Flovent dosages

Previous therapy	Starting dosage	Maximum dosage
Bronchodilator alone	88 mcg inhaled orally b.i.d.	440 mcg inhaled orally b.i.d.
Inhaled corticosteroid	88-220 mcg inhaled orally b.i.d.	440 mcg inhaled orally b.i.d.
Oral corticosteroid	880 mcg inhaled orally b.i.d.	880 mcg inhaled orally b.i.d.

Contraindications

• Hypersensitivity to drug or its components
• Primary treatment of status asthmaticus or other acute asthma episodes necessitating intensive measures (Flovent)
• Severe allergy to milk proteins

Precautions

Use cautiously in:
• recurrent epistaxis, recent nasal septal ulcer, nasal surgery, or trauma
• severe hepatic disease (Veramyst)
• glaucoma and cataracts
• tuberculosis; respiratory tract infection; fungal, bacterial, viral, or parasitic infections; ocular herpes simplex
• hypercorticism and adrenal suppression (when used at higher than recommended dosages or in susceptible persons)
• concurrent use of other CYP3A inhibitors (such as ketoconazole; use not recommended with ritonavir)
• Candida albicans infection (Veramyst)
• elderly patients (Flonase, Veramyst)
• pregnant or breastfeeding patients (Flovent, Flonase, Veramyst)
• children (Flovent)
• children younger age than 4 (Flonase).
• children younger than age 2 (Veramyst).

Administration

• Know that Flonase may cause immediate hypersensitivity reaction (contact dermatitis).
• Be aware that topical ointment should be used in adults only.
• Prime Veramyst nasal spray before first use, when not used for more than 30 days, or if cap has been left off bottle for 5 days or more.

Route	Onset	Peak	Duration
Oral or nasal inhalation, topical	Unknown	Unknown	Unknown

Adverse reactions

CNS: Cutivate ointment - light-headedness; Flonase - headache, dizziness; Flovent - headache, dizziness, giddiness; Veramyst - headache

EENT: Flonase - cataract, glaucoma, increased intraocular pressure, epistaxis, nasal burning or irritation, bloody nasal mucus, runny nose, pharyngitis; Flovent - nasal congestion, nasal septum perforation, nasal discharge, nasal sinus pain, sinusitis, rhinitis, allergic rhinitis, pharyngitis, dysphonia; Veramyst - cataract, glaucoma, increased intraocular pressure, epistaxis, pharyngolaryngeal pain, nasal ulceration

GI: Flonase - nausea, vomiting, diarrhea, abdominal pain; Flovent - nausea, vomiting, diarrhea, dyspepsia, stomach disorder, oral candidiasis

GU: Flovent - dysmenorrhea

Metabolic: Veramyst - hypercorticism and adrenal suppression

Musculoskeletal: Flonase - aches and pains; Flovent - joint pain, limb pain, sprain, strain, aches and pains; Veramyst - back pain

Respiratory: Flonase - asthma symptoms, cough, bronchitis, wheezing (rare); Flovent - upper respiratory tract infection, influenza, bronchitis, chest congestion, bronchospasm; Veramyst - cough

Skin: Cutivate cream - pruritus, skin dryness, skin burning, erythematous rash, dusky erythema, eczema exacerbation, skin irritation, urticaria; Cutivate ointment - skin burning or irritation, hypertrichosis, increased erythema, hives; Flovent - urticaria, rash, skin eruption

Other: Cutivate cream or ointment - numbness of fingers, facial or nonfacial telangiectasia; Flonase - fever, flulike symptoms, hypersensitivity reaction; Flovent - dental problems, fever, immediate or delayed hypersensitivity reactions, angioedema; Veramyst - pyrexia

Interactions

Drug-drug. Ketoconazole, other strong CYP3A inhibitors: increased fluticasone exposure (with Flonase, Flovent, Veramyst)

Ritonavir: increased systemic corticosteroid effects (with Flonase, Flovent, Veramyst)

Drug-diagnostic tests. Adrenocorticotropic hormone stimulation test, plasma cortisol test, urinary free cortisol test: interference with test results

Patient monitoring

☞ Monitor patient for withdrawal symptoms after Flovent is discontinued.
• Stay alert for systemic corticosteroid effects when administering Flovent, Flonase, or Veramyst.
• Observe for reduced growth rate in child or adolescent using Flovent, Flonase or Veramyst.
• When giving Flovent, watch for eosinophilic conditions, such as Churg-Strauss syndrome.
☞ When giving Flonase, assess for epistaxis, wheezing, nasal septum perforation, cataracts, glaucoma, and increased intraocular pressure (rare reaction).
☞ When giving Veramyst, assess for epistaxis, nasal septum perforation, cataracts, glaucoma, and increased intraocular pressure (rare reaction).

Patient teaching

• Tell patient to take drug exactly as prescribed.
• Teach patient proper use of prescribed form.
☞ Advise patient to immediately report signs of allergic reaction.
• Caution patient to avoid exposure to people with chickenpox or measles.
• Advise female patient taking Flonase, Flovent, or Veramyst to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.