Fluticasone Indications and Dosage
- allergic rhinitis
- alopecia
- asthma
- atopic dermatitis
- chronic obstructive pulmonary disease (COPD) †
- contact dermatitis
- dermatitis
- discoid lupus erythematosus
- eczema
- exfoliative dermatitis
- lichen planus
- lichen simplex
- lichen striatus
- pemphigus
- polymorphous light eruption
- pompholyx
- prurigo
- pruritus
- psoriasis
- Rhus dermatitis
- seborrheic dermatitis
- xerosis
† non-FDA-approved indication
Fluticasone Indications and Dosage
General Comparative Topical Corticosteroid Potency:
NOTE: The following is a general representation. Check specific product formulations prior to making potency decisions.
Very High Potency
Betamethasone dipropionate (augmented)
Clobetasol
Diflorasone diacetate ointment
Halobetasol
High Potency
Amcinonide
Betamethasone dipropionate
Desoximetasone gel or ointment, or cream >= 0.25%
Diflorasone diacetate cream
Fluocinolone cream >= 0.2%
Fluocinonide
Halcinonide
Triamcinolone >= 0.5%
Medium Potency
Beclomethasone
Betamethasone benzoate
Betamethasone valerate
Clobetasone
Desoximetasone cream < 0.25%
Diflucortolone
Fluocinolone ointment or topical solution or cream < 0.2%
Flurandrenolide >= 0.025%
Fluticasone
Hydrocortisone butyrate
Hydrocortisone valerate
Mometasone
Triamcinolone < 0.5%
Low Potency
Alclometasone
Clocortolone
Desonide
Dexamethasone
Flumethasone
Flurandrenolide < 0.025%
Hydrocortisone base
Hydrocortisone acetate
For the treatment of pruritus and topical inflammation associated with moderate to severe corticosteroid-responsive dermatoses, including the treatment of alopecia areata, atopic dermatitis, discoid lupus erythematosus, eczema (including hyperkeratotic eczema, nummular eczema, and severe eczematous conditions of the hands or feet), generalized exfoliative dermatitis, cutaneous lichen planus, lichen simplex chronicus, lichen striatus, nodular prurigo, pompholyx (dyshidrosis), pemphigus, polymorphous light eruption, psoriasis, seborrheic dermatitis, severe contact dermatitis, severe Rhus dermatitis (due to plants like poison ivy), and xerosis:
NOTE: Occlusive dressings may be required for chronic or severe cases of lichen simplex chronicus, psoriasis, eczema, atopic dermatitis, or chronic hand eczema. More potent topical corticosteroids and/or occlusive dressings may be necessary for the treatment of discoid lupus erythematosus, lichen planus, granuloma annulare, psoriatic plaques, and psoriasis of the palms, soles, elbows, or knees.
Topical dosage (cream or ointment):
Adults, elderly and adolescents: 0.005% ointment or 0.05% cream applied sparingly to the affected area twice daily. Each treatment course may continue for up to 4 weeks. In the treatment of psoriasis, studies suggest that patients respond preferentially to the 0.005% ointment. In the treatment of eczema, fluticasone cream 0.05% applied once daily is as effective as twice daily application.
Children and infants >= 3 months of age: Fluticasone cream 0.05% applied sparingly to the affected area once daily or twice daily. Only fluticasone cream 0.05% has been approved for the treatment of atopic dermatitis in this population. In clinical trials, the 0.05% cream has been applied once daily to children for the treatment of atopic dermatitis for up to 4 weeks.
Topical dosage (lotion):
Adults, adolescents, and children: apply 0.05% lotion sparingly to the affected area once daily. Each treatment course may continue for up to 4 weeks.
For management of nasal symptoms of seasonal or perennial allergic rhinitis or perennial nonallergic rhinitis:
Nasal inhalation dosage:
Adults: 2 sprays (note 1 spray = 50 mcg) per nostril once daily or 1 spray (50 mcg) per nostril twice daily; total dose of 200 mcg/day. After the first few days, may reduce to 1 spray per nostril once daily based on patient response. Those with severe symptoms or unresponsive to the lower dose may be started at higher dosage. Maximum dosage 200 mcg/day. Alternatively, some patients with seasonal allergic rhinitis may find ‘as-needed’ use of 200 mcg once daily effective, however, greater symptom control may occur with scheduled regular use.
Adolescents and children > = 4 years: 1 spray (50 mcg) per nostril once daily (total daily dose of 100 mcg). The dose may be increased up to 2 sprays per nostril once daily (i.e., maximum dosage 200 mcg/day) if unresponsive to initial dose; then titrate downward based on patient response. Alternatively, some children >= 12 years with seasonal allergic rhinitis may find ‘as needed’ use of 200 mcg once daily effective, however, greater symptom control may occur with scheduled regular use.
Children < 4 years: Safe and effective dosage has not been established.
For the maintenance treatment of asthma or chronic obstructive pulmonary disease (COPD) † :
NOTE: Different product formulations provide different quantities of active drug.
Oral inhalation aerosol dosage (Flovent® HFA aerosol products):
NOTE: The metered-dose inhalers for oral inhalation deliver either 44 mcg/spray, 110 mcg/spray, or 220 mcg/spray depending on the formulation selected.
Adults, adolescents, and children >= 12 years previously treated with bronchodilators alone: 88 mcg (1 spray = 44 mcg) via oral inhalation twice daily; not to exceed 440 mcg twice daily.
Adults, adolescents, and children >= 12 years previously treated with other inhaled corticosteroids: 88 - 220 mcg (1 spray = 44 mcg, 110 mcg, or 220 mcg) via oral inhalation twice daily; not to exceed 440 mcg twice daily.
Adults, adolescents, and children >= 12 years previously treated with oral corticosteroids: 440 mcg (1 spray = 220 mcg with the maximum product formulation) via oral inhalation twice daily; not to exceed 880 mcg twice daily. After at least 1 week of fluticasone therapy, consider slow reduction of the oral corticosteroid. Monitor patient for signs of asthma instability and for signs of adrenal insufficiency during withdrawal.
Children 4 - 11 years: 88 mcg (1 spray = 44 mcg) via oral inhalation twice daily regardless of prior therapy; do not exceed 88 mcg twice daily.
Children < 4 years: Safe and effective use has not been established.
Oral inhalation aerosol dosage (Flovent® aerosol products):
NOTE: This product was discontinued in the United States in February 2005.
NOTE: The metered-dose inhalers for oral inhalation deliver either 44 mcg/spray, 110 mcg/spray, or 220 mcg/spray depending on the formulation selected.
Adults, adolescents, and children >= 12 years previously treated with bronchodilators alone: 88 mcg (1 spray = 44 mcg) via oral inhalation twice daily; not to exceed 440 mcg twice daily.
Adults, adolescents, and children >= 12 years previously treated with other inhaled corticosteroids: 88 - 220 mcg (1 spray = 44 mcg, 110 mcg, or 220 mcg) via oral inhalation twice daily; not to exceed 440 mcg twice daily.
Adults, adolescents, and children >= 12 years previously treated with oral corticosteroids: 880 mcg (1 spray = 220 mcg with the maximum product formulation) via oral inhalation twice daily; not to exceed 880 mcg twice daily. After at least 1 week of fluticasone therapy, consider slow reduction of the oral corticosteroid. Monitor patient for signs of asthma instability and for signs of adrenal insufficiency during withdrawal.
Children < 12 years: Safe and effective use has not been established.
Oral inhalation powder dosage (i.e., Rotadisk®):
NOTE: This product was discontinued in the United States in September 2004.
NOTE: One 50 mcg blister actuation = 44 mcg delivered; one 100 mcg blister actuation = 88 mcg delivered; one 250 mcg blister actuation = 220 mcg delivered.
Adults, elderly, and adolescents previously treated with bronchodilators only: Initially, 88 mcg via oral inhalation twice daily; not to exceed 440 mcg twice daily.
Adults, elderly, and adolescents previously treated with other inhaled corticosteroids: Initially, 88 - 220 mcg via oral inhalation twice daily; not to exceed 440 mcg twice daily.
Adults, elderly, and adolescents currently receiving chronic oral corticosteroids: Initially, 880 mcg via oral inhalation twice daily. After at least 1 week of therapy with fluticasone inhalation, consider slow reduction of the oral corticosteroid. Monitor patient for signs of asthma instability and for signs of adrenal insufficiency during withdrawal. Once oral corticosteroid dosage reduction is complete, reduce the dosage of inhaled fluticasone to the lowest effective dosage.
Children 4 - 11 years previously treated with bronchodilators only: Recommended starting dose is 44 mcg via oral inhalation twice daily; not to exceed 88 mcg twice daily.
Children 4 - 11 years previously treated with other inhaled corticosteroids: Recommended starting dose is 44 mcg via oral inhalation twice daily; not to exceed 88 mcg twice daily.
Children 4 - 11 years currently receiving chronic oral corticosteroids: Dosage titration guidelines for fluticasone have not been established.
Children < 4 years: Safe and effective use has not been established.
Maximum Dosage Limits:
In general, corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease, route and product of administration, and on patient age and response. For some products maximum dosage limits have not been specified.
- Adults: 200 mcg/day intranasally; 1760 mcg/day via oral inhalation.
- Elderly: 200 mcg/day intranasally; 1760 mcg/day via oral inhalation.
- Adolescents: 200 mcg/day intranasally; 1760 mcg/day via oral inhalation.
- Children >= 4 years: 200 mcg/day intranasally.
- Children 4 - 11 years: 176 mcg/day via oral inhalation.
- Children < 4 years: Safe and effective use of nasal and oral inhalation formulations have not been established.
Patients with hepatic impairment:
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with renal impairment:
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
[ Last revised: 3/10/2006 6:06:00 PM ]
References
. Wolkerstorfer A, Strobos MA, Glazenberg EJ, et al. Fluticasone propionate 0.05% cream once daily versus clobetasol butyrate 0.05% cream twice daily in children with atopic dermatitis. J Am Acad Dermatol 1998;39:226 - 31.
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