Fluticasone

Inhaled Glucocorticoid·Respiratory - Asthma & COPD

Asthma prophylaxis, severe COPD

Authority requiredPBSSTEROIDFlixotide, Seretide (combo), Breo Ellipta (combo)MDI (50, 125, 250 mcg/actuat…+2

Max Dose

1000 mcg/day

Half-life

8-14 h

Lipophilic

HIGH

Systemic Abs.

LOW

Rapid Summary

Overview

Highly lipophilic, extremely potent inhaled corticosteroid. Stronger receptor binding than budesonide, providing excellent local control with minimal systemic swallowing absorption.

Maximum Dose

Max 1000 mcg/day (Adults).

Clinical Focus

Fluticasone Propionate (Flixotide) and Fluticasone Furoate (Arnuity) have different potencies and dosing regimens. Do not mix them up.

Bottom Line

Fluticasone is a highly potent inhaled corticosteroid for moderate-severe asthma, but has greater systemic absorption than budesonide increasing adrenal suppression risk at high doses.

Formulation & Access

Brand Names

Flixotide, Seretide (combo), Breo Ellipta (combo)

Oral Routes

MDI (50, 125, 250 mcg/actuation). Dry powder Accuhaler/Ellipta.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Asthma prophylaxis, severe COPD.

Clinical Place

Highly prescribed maintenance inhaler. The Furoate salt allows for ultra-convenient once-daily dosing.

Quick reference

Class & Role

Inhaled Glucocorticoid — Highly lipophilic, extremely potent inhaled corticosteroid.

Route / Formulation

MDI (50, 125, 250 mcg/actuation). Dry powder Accuhaler/Ellipta. (Flixotide, Seretide (combo), Breo Ellipta (combo))

Usual Dose & Max

Inhaled 100-500 mcg BD. Max 1000 mcg/day.

Key Indication Doses

Asthma Maintenance (Propionate): Inhaled 100-500 mcg BD. Max 1000 mcg/day. Asthma Maintenance (Furoate): Inhaled 100-200 mcg OD. COPD (Combo only): Inhaled Typically given combined with Salmeterol (Seretide) or Vilanterol (Breo).

Best Uses

Fluticasone is a highly potent inhaled corticosteroid for moderate-severe asthma, but has greater systemic absorption than budesonide increasing adrenal suppression risk at high doses.

Avoid / Cautions

Acute asthma attacks (not a reliever). Pregnancy Category B3 (Budesonide is generally preferred in pregnancy, though fluticasone is continued if the patient is stable on it).

Key Risks

Oral/Pharyngeal: Oropharyngeal candidiasis, dysphonia. Respiratory: Paradoxical bronchospasm upon inhalation (often due to the propellant, use a spacer). Endocrine: Adrenal suppression at extremely high doses, though less likely than with Beclometasone due to 99% hepatic clearance of swallowed fractions.

Key Interactions

CYP3A4 inhibitors (Ritonavir, Cobicistat) completely block hepatic breakdown. Swallowed fluticasone builds up, causing profound iatrogenic Cushing's syndrome and adrenal crisis.

Monitoring

Ensure 'rinse and spit' routine to prevent thrush. No specific routine laboratory tests required.

Clinical Pearl

Never prescribe Fluticasone to a patient on HIV/HCV protease inhibitors (Ritonavir). It is a classic exam and ward error resulting in rapid, severe adrenal suppression.

Access

Authority requiredFlixotide, Seretide (combo), Breo Ellipta (combo)MDI (50, 125, 250 mcg/actuat…

Brand: Flixotide, Seretide (combo), Breo Ellipta (combo)
PBS status: Authority required
Formulation: MDI (50, 125, 250 mcg/actuation)

Fluticasone

Inhaled Glucocorticoid·Respiratory - Asthma & COPD

Asthma prophylaxis, severe COPD

Authority requiredPBSSTEROIDFlixotide, Seretide (combo), Breo Ellipta (combo)MDI (50, 125, 250 mcg/actuat…+2

Max Dose

1000 mcg/day

Half-life

8-14 h

Lipophilic

HIGH

Systemic Abs.

LOW

Rapid Summary

Overview

Highly lipophilic, extremely potent inhaled corticosteroid. Stronger receptor binding than budesonide, providing excellent local control with minimal systemic swallowing absorption.

Maximum Dose

Max 1000 mcg/day (Adults).

Clinical Focus

Fluticasone Propionate (Flixotide) and Fluticasone Furoate (Arnuity) have different potencies and dosing regimens. Do not mix them up.

Bottom Line

Fluticasone is a highly potent inhaled corticosteroid for moderate-severe asthma, but has greater systemic absorption than budesonide increasing adrenal suppression risk at high doses.

Formulation & Access

Brand Names

Flixotide, Seretide (combo), Breo Ellipta (combo)

Oral Routes

MDI (50, 125, 250 mcg/actuation). Dry powder Accuhaler/Ellipta.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Asthma prophylaxis, severe COPD.

Clinical Place

Highly prescribed maintenance inhaler. The Furoate salt allows for ultra-convenient once-daily dosing.

Quick reference

Class & Role

Inhaled Glucocorticoid — Highly lipophilic, extremely potent inhaled corticosteroid.

Route / Formulation

MDI (50, 125, 250 mcg/actuation). Dry powder Accuhaler/Ellipta. (Flixotide, Seretide (combo), Breo Ellipta (combo))

Usual Dose & Max

Inhaled 100-500 mcg BD. Max 1000 mcg/day.

Key Indication Doses

Best Uses

Fluticasone is a highly potent inhaled corticosteroid for moderate-severe asthma, but has greater systemic absorption than budesonide increasing adrenal suppression risk at high doses.

Avoid / Cautions

Acute asthma attacks (not a reliever). Pregnancy Category B3 (Budesonide is generally preferred in pregnancy, though fluticasone is continued if the patient is stable on it).

Key Risks

Key Interactions

CYP3A4 inhibitors (Ritonavir, Cobicistat) completely block hepatic breakdown. Swallowed fluticasone builds up, causing profound iatrogenic Cushing's syndrome and adrenal crisis.

Monitoring

Ensure 'rinse and spit' routine to prevent thrush. No specific routine laboratory tests required.

Clinical Pearl

Never prescribe Fluticasone to a patient on HIV/HCV protease inhibitors (Ritonavir). It is a classic exam and ward error resulting in rapid, severe adrenal suppression.

Access

Authority requiredFlixotide, Seretide (combo), Breo Ellipta (combo)MDI (50, 125, 250 mcg/actuat…

Brand: Flixotide, Seretide (combo), Breo Ellipta (combo)
PBS status: Authority required
Formulation: MDI (50, 125, 250 mcg/actuation)