Inhaled corticosteroids · Respiratory
Fluticasone
fluticasone propionate · fluticasone furoate · Flovent® · Arnuity® · Flonase®(brand names vary by market)
The controller that does nothing today and everything over weeks.
Also: topical
Mechanism
A potent glucocorticoid delivered topically to the airway, reducing eosinophilic inflammation, mucus production and bronchial hyper-responsiveness.
Indications
- Asthma, maintenance
- COPD in selected patients
- Allergic rhinitis (nasal formulations)
Formulations
Dosing concepts
It is not a reliever
It has no bronchodilator effect and does nothing for acute breathlessness. Patients who expect relief from it abandon it, and patients who rely on their reliever alone are at risk of dying of asthma.
Technique over dose
A poorly used inhaler at a high dose delivers less than a well-used one at a low dose. Technique is checked at every review, not assumed.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- Minimal orally due to near-complete first-pass metabolism; systemic exposure is chiefly from the lung fraction
- Half-life
- ~8 h
- Elimination
- hepatic: CYP3A4; ritonavir and strong inhibitors can cause iatrogenic Cushing syndrome
- Protein binding
- ~90%
Adverse effects
- Oral candidiasiscommonLargely preventable by rinsing and spitting, and by using a spacer.
- Dysphoniacommon
- Pneumonia in COPDserious
- Adrenal suppression at high dosesserious
- Reduced growth velocity in childrenseriousSmall and largely recovered, and far less harmful than uncontrolled asthma.
Contraindications & precautions
Contraindications
- Not for acute bronchospasm
Precautions
- Concurrent strong CYP3A4 inhibitors
- Untreated respiratory infection
- High-dose long-term use
Interactions
Monitoring
Inhaler technique
The most common reason a controller appears not to work · At every single review
Reliever use frequency
Three or more times a week means the controller is inadequate
Mouth for candidiasis
Common and easily fixed
Growth in children on long-term therapy
Small effect worth tracking
Counselling points
- This is your preventer. Take it every day even when you feel completely well.
- It will not help an attack; that is what your reliever is for.
- Rinse your mouth and spit after every dose.
- Use a spacer if you have one: it gets more of the drug into the lungs and less into your mouth.
- If you are using your reliever three or more times a week, tell us.
Clinical pearls
- Reliever-only asthma treatment is now considered unsafe: the deaths occur in patients whose disease looked mild and who were never on a controller.
- Almost all inhaled-steroid candidiasis is a rinsing or technique problem, and thirty seconds of teaching prevents it.
References & review
- Fluticasone product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.