Introduction
Flovent (fluticasone propionate) is an inhaled corticosteroid medication used primarily for the maintenance treatment of asthma as prophylactic therapy. It is not intended for relief of acute bronchospasm. Flovent works locally in the lungs to reduce inflammation and prevent asthma symptoms.
Mechanism of Action
Fluticasone propionate is a synthetic trifluorinated corticosteroid that exerts potent anti-inflammatory effects in the airways. It binds to glucocorticoid receptors in lung tissue, activating them to:
- Inhibit multiple inflammatory cells (mast cells, eosinophils, macrophages, lymphocytes)
- Decrease production of inflammatory mediators (cytokines, leukotrienes, prostaglandins)
- Reduce mucosal edema and airway hyperresponsiveness
- Decrease vascular permeability and mucus production
The drug has high affinity for glucocorticoid receptors and demonstrates minimal systemic absorption at recommended doses.
Indications
FDA-approved indications:
- Maintenance treatment of asthma as prophylactic therapy in patients aged 4 years and older
- Prevention of asthma exacerbations
Off-label uses (with clinical evidence):
- Maintenance treatment of eosinophilic bronchitis
- Adjunctive treatment in COPD with asthmatic components
Dosage and Administration
Available formulations:- Flovent HFA (metered dose inhaler): 44 mcg, 110 mcg, 220 mcg per actuation
- Flovent Diskus (dry powder inhaler): 50 mcg, 100 mcg, 250 mcg per blister
- Starting dose: 88 mcg twice daily (HFA) or 100 mcg twice daily (Diskus)
- Maximum dose: 880 mcg daily (divided twice daily)
- Starting dose: 88 mcg twice daily (maximum 176 mcg daily)
- Titrate to lowest effective dose
- Shake HFA inhaler well before each use
- Rinse mouth after inhalation to prevent oral candidiasis
- Use spacer device with HFA for improved lung deposition
- Do not exceed recommended doses
- Not for acute bronchospasm relief
- Hepatic impairment: Use with caution
- Renal impairment: No dosage adjustment needed
- Elderly: Start at lower end of dosing range
Pharmacokinetics
Absorption: Systemic absorption occurs primarily through lung tissue (30% of delivered dose). Oral bioavailability is <1% due to extensive first-pass metabolism. Distribution: Volume of distribution approximately 4.2 L/kg. Plasma protein binding is 91%. Minimal distribution to central nervous system. Metabolism: Extensive first-pass metabolism via cytochrome P450 3A4 to inactive metabolites. Elimination: Terminal half-life approximately 8 hours. Excreted primarily in feces (<95%) with minimal renal excretion.Contraindications
- Hypersensitivity to fluticasone propionate or any component of the formulation
- Primary treatment of status asthmaticus or other acute asthma episodes
- Active or quiescent tuberculosis infections of respiratory tract
- Untreated fungal, bacterial, or viral infections
- Ocular herpes simplex
Warnings and Precautions
Systemic effects: May occur, particularly at higher doses, including:- Adrenal suppression
- Reduced bone mineral density
- Growth suppression in children
- Glaucoma and cataracts
Drug Interactions
Strong CYP3A4 inhibitors: Ketoconazole, ritonavir, clarithromycin - may increase fluticasone levels and systemic effects (use with caution) Other inhaled medications: Administer bronchodilators prior to corticosteroids for improved penetration Live vaccines: Avoid administration during high-dose therapyAdverse Effects
Common (>10%):- Oropharyngeal candidiasis
- Hoarseness/dysphonia
- Throat irritation
- Headache
- Upper respiratory infection
- Cough
- Nausea
- Oral candidiasis
- Sinusitis
- Adrenal suppression
- Severe bronchospasm
- Angioedema
- Anaphylaxis
- Osteoporosis with long-term use
- Growth suppression in children
- Glaucoma/cataracts
- Eosinophilic conditions
Monitoring Parameters
Clinical monitoring:- Asthma symptoms and control (ACT scores)
- Peak flow measurements
- Growth velocity in children (every 3-6 months)
- Oral examination for candidiasis
- No routine laboratory monitoring required
- Consider morning cortisol levels with high-dose therapy
- Bone density scans with long-term high-dose use
- Ophthalmologic exams annually with prolonged use
- Reduction in asthma exacerbations
- Improved pulmonary function tests
- Reduced rescue medication use
Patient Education
Proper technique:- Demonstrate correct inhaler use with return demonstration
- Use spacer with MDI for better drug delivery
- Rinse mouth after each use to prevent thrush
- Use regularly, even when feeling well
- Do not stop abruptly without medical supervision
- Not for acute asthma attacks
- Report worsening asthma symptoms
- Watch for signs of oral thrush (white patches)
- Monitor for systemic effects (weight gain, bruising)
- Carry rescue inhaler at all times
- Inform all healthcare providers of Flovent use
- Keep regular follow-up appointments
- Use lowest effective dose
- Store at room temperature
- Do not puncture or incinerate
- Keep away from extreme heat
- Note expiration dates
References
1. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. NIH Publication No. 07-4051. 2007.
2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023.
3. Flovent [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2022.
4. Barnes PJ. Inhaled corticosteroids. Pharmaceuticals (Basel). 2010;3(3):514-540.
5. Kelly HW. Comparison of inhaled corticosteroids. Ann Pharmacother. 1998;32(2):220-232.
6. Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy. Arch Intern Med. 1999;159(9):941-955.
7. Allen DB. Inhaled corticosteroids and growth effects in children. Curr Opin Endocrinol Diabetes Obes. 2006;13(1):25-29.
Note: This information is for educational purposes only and does not replace professional medical advice. Always consult with a healthcare provider for personalized medical recommendations.