Flonase


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fluticasone propionate

Cutivate, Flixonase (UK), Flixotide (UK), Flonase, Flovent Diskus, Flovent HFA

fluticasone furoate

Avamys (CA), 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, metered (Flovent HFA): 44 mcg, 110 mcg, 220 mcg

Inhalation powder, metered (Flovent Diskus): 50 mcg, 100 mcg, 250 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 and treatment of asthma for patients requiring oral corticosteroid therapy (Flovent HFA and Flovent Diskus)

Adults and children age 4 and older: Recommended starting dosage and highest recommended dosage, based on prior asthma therapy, are listed in charts below.

Recommended Flovent FHA dosages

For Adults and adolescents age 12 and older

Recommended Flovent Diskus dosages

Seasonal and perennial allergic and nonallergic rhinitis (Flonase)

Adults: Two sprays in each nostril daily or one spray in each nostril b.i.d. After first few days, may reduce dosage to one spray in each nostril daily; some patients may find p.r.n. use of two sprays in each nostril daily effective for symptom control. Maximum dosage is 200 mcg daily (two sprays in each nostril).

Adolescents and children ages 4 and older: Initially, one spray in each nostril daily. If patient doesn't respond, may increase to two sprays in each nostril. Once adequate control is achieved, reduce dosage to one spray in each nostril daily.

Symptoms of seasonal and perennial allergic rhinitis (Veramyst)

Adults and adolescents age 12 and older: 110 mcg (2 sprays per nostril) once daily

Children ages 2 to 11: 55 mcg (1 spray per nostril) once daily

Inflammatory and pruritic manifestations of corticosteroid-responsive atopic dermatoses

Adults and children ages 3 months and older: Apply thin film of Cutivate cream to affected skin area once or twice daily.

Other corticosteroid-responsive dermatoses

Adults and children ages 3 months and older: Apply thin film of Cutivate cream to affected skin area b.i.d.

Contraindications

• Hypersensitivity to drug or its components

• Primary treatment of status asthmaticus or other acute asthma episodes necessitating intensive measures (Flovent FHA, Flovent Diskus)

• Severe allergy to milk proteins (Flovent Diskus)

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 (Flovent, Veramyst)

• elderly patients (Flonase, Veramyst)

• pregnant or breastfeeding patients (Flovent, Flonase, Veramyst)

• children younger age than 4 (Flonase, Flovent)

• 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.

• Administer inhalation powder by oral inhalation only.

Adverse reactions

CNS: Cutivate ointment-lightheadedness; 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-cataract, glaucoma, 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: Flovent, Veramyst-hypercorticism and adrenal suppression

Musculoskeletal: Flonase-aches and pains; Flovent-joint pain, limb pain, sprain, strain, aches and pains, reduced bone mineral density; 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, C. albicans infection, immunosuppression, immediate or delayed hypersensitivity reactions, angioedema; anaphylaxis; 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.

fluticasone (nasal)

(floo-ti-ka-sone) ,

Avamys

(trade name),

Flonase

(trade name),

Veramyst

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Seasonal or perennial allergic rhinitis.Seasonal or perennial nonallergic rhinitis (Flonase only).

Action

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects

Decrease in symptoms of allergic and nonallergic rhinitis.

Pharmacokinetics

Absorption: <2%; action is primarily local following nasal use.
Distribution: Crosses the placenta and enters breast milk in small amounts.
Metabolism and Excretion: Rapidly and extensively metabolized by the liver; primarily excreted in feces; <5% excreted in urine.
Half-life: 7.8 hr.

Time/action profile (improvement in symptoms)

ROUTEONSETPEAKDURATION
Intranasalfew daysup to 3 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity (Flonase contains alcohol).
Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (due to disease or concurrent therapy); Systemic corticosteroid therapy (should not be abruptly discontinued when intranasal therapy is started); Concurrent use of ritonavir; Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <4 yr (for Flonase) or <2 yr (for Veramyst) (safety not established; prolonged or high-dose therapy may lead to complications).

Adverse Reactions/Side Effects

Central nervous system

  • headache

Ear, Eye, Nose, Throat

  • epistaxis
  • nasal burning
  • nasal irritation
  • nasopharyngeal fungal infection
  • pharyngitis

Gastrointestinal

  • nausea
  • vomiting

Endocrinologic

  • adrenal suppression (↑ dose, long-term therapy only)
  • ↓ growth (children)

Dermatologic

  • rash
  • urticaria

Respiratory

  • cough

Miscellaneous

  • anaphylaxis
  • angioedema

Interactions

Drug-Drug interaction

Ritonavir and ketoconazole ↓ metabolism and ↑ levels of fluticasone. Concomitant use of ritonavir and fluticasone not recommended.

Route/Dosage

Intranasal (Adults) Flonase–2 sprays in each nostril once daily or 1 spray in each nostril twice daily (not to exceed 2 sprays in each nostril/day); after several days, attempt to ↓ dose to 1 spray in each nostril once daily. Patients ≥ 12 yr with seasonal allergic rhinitis may also use 2 sprays in each nostril once daily on an as-needed basis; Veramyst–2 sprays in each nostril once daily or 1 spray in each nostril twice daily; once symptoms controlled, attempt to ↓ dose to 1 spray in each nostril once daily.
Intranasal (Children ≥4 yr) Flonase–1 spray in each nostril once daily (not to exceed 2 sprays in each nostril/day).
Intranasal (Children 2–11 yrs) Veramyst–1 spray in each nostril daily; may ↑ to 2 sprays if no response; once symptoms controlled, attempt to ↓ dose to 1 spray/day.

Availability (generic available)

Nasal spray (Flonase): 50 mcg/metered spray in 16-g bottle (delivers 120 metered sprays)
Nasal spray (Veramyst): 27.5 mcg/spray in a 10-g bottle (delivers 120 sprays)
In combination with: azelastine (Dymista); see combination drugs).

Nursing implications

Nursing assessment

  • Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.
    • Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
    • Monitor growth rate in children receiving chronic therapy; use lowest possible dose.
  • Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritis, swelling of face and neck, dyspnea) periodically during therapy.
  • Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Do not confuse Flovent (fluticasone oral inhalation) with Flonase (fluticasone nasal spray).
  • After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
  • Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before corticosteroid nasal spray. If patient is unable to breathe freely through nasal passages, instruct patient to blow nose gently in advance of medication administration.

Patient/Family Teaching

  • Advise patient to take medication exactly as directed. Take missed doses as soon as remembered unless almost time for next dose.
  • Instruct patient in correct technique for administering nasal spray (see ). Shake well before use. Before first-time use, prime unit by spraying 6 times. If not used for at least 7 days or if cap left off for more than 5 days, reprime unit. Warn patient that temporary nasal stinging may occur.
  • Instruct patient to stop fluticasone and notify health care professional immediately if signs of anaphylaxis (rash, hives, difficulty breathing, swollen lips or throat) occur.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking other Rx, OTC, or herbal products.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
  • Instruct patient to notify health care professional if symptoms do not improve within 1 mo or if symptoms worsen.

Evaluation/Desired Outcomes

  • Resolution of nasal stuffiness, discharge, and sneezing in seasonal or perennial rhinitis.

Flonase

(flō′nāz′)
A trademark for the drug fluticasone propionate.

Flonase

Fluticasone propionate, see there.
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References in periodicals archive ?
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By collaborating with Weather, we are able to tap into their scale and get the Allergy Tracker as well as the Flonase Sensimist Allergy Relief campaign in front of nearly a quarter billion consumers across the Weather properties.
GSK Consumer Healthcare, a science-led global healthcare company, has introduced a new over-the-counter treatment for symptoms associated with seasonal and perennial allergies, branded as Flonase Sensimis Allergy Relief (fluticasone furoate, 27.
Making sure they get their share of products like Nexium and Flonase, which were billion-dollar businesses as prescriptions, are big opportunities they should not miss.
The company's motivation for Veramyst is probably the fact the fluticasone went off patent, and a generic substitute for Flonase became available.
She recommends over-the-counter Claritin or the prescription antihistamines Zyrtec and Allegra, as well as the nasal steroid sprays Nasonex and Flonase.
Glaxo is also expected to have taken a knock from an increase in US competition to its anti-nausea drug Zofran, anti- depressant Wellbutrin and allergy treatment Flonase.
Generic Drug Update: As we go to press, physicians may now opt to prescribe generic forms of Pravachol (pravastatin sodium), Zocor (simvastatin), Flonase (fluticasone propionate), and Proscar (finasteride).
Huynh observing the patient's oropharynx to be red and inflamed, diagnosed allergic rhinitis/sinusitis, and ordered a trial of Claritin with Flonase and, if no response, antibiotics.
TABLE Intranasal steroids for treating allergic rhinitis Cost per Drug Usual adult dosages month * Beclomethasone dipropionate Beconase AQ 2 sprays/nostril qd $44 Vancenase AQ 2 sprays/nostril qd $40 Budesonide Rhinocort AQ 2 sprays/nostril bid $48 Flunisolide Nasarel 2 sprays/nostril bid $44 Nasalide 2 sprays/nostril bid $46 Fluticasone propionate Flonase 2 sprays/nostril qd $53 Mometasone furoate Nasonex 2 sprays/nostril qd $56 Triamcinolone acetonide Nasacort AQ 2 sprays/nostril qd $56 bid, twice a day; qd, every day.
She reported on 99 patients aged 18 or older who participated in the Ceftin and Flonase for Sinusitis (CAFFS) trial, a double-blind, randomized, placebo-controlled study that was conducted at 12 primary care and 10 otolaryngology practice sites.
She reported on 99 patients aged 18 or older in the Ceftin and Flonase for Sinusitis (CAFFS) trial, a double-blind, randomized, placebo-controlled study conducted at 12 primary care and 10 otolaryngology practice sites.