What is fluticasone propionate?
Fluticasone propionate is a corticosteroid, a class of drugs that also includes methylprednisolone, prednisone, and budesonide. It is sold under the brand names Flonase and Flovent, among others, and is available as a generic medication.
Corticosteroids are steroid hormones that occur naturally in your body, while synthetic versions (such as fluticasone propionate) are used medicinally. Corticosteroids are involved in several processes, including your immune response, inflammation, and metabolism. Corticosteroids can be further categorized, with the main classes being glucocorticoids and mineralocorticoids. Glucocorticoids are the type of corticosteroids that influence your immune response and inflammation.
Fluticasone propionate is a glucocorticoid and therefore has anti-inflammatory effects. This is why you may see it referred to as both a corticosteroid and glucocorticoid. It is available as a nasal spray, oral inhaler formulation, in topical forms that are applied directly on the skin, and (in some markets) nasal drops. The form of fluticasone propionate you may be prescribed depends on the condition it is being used to treat.
What is fluticasone propionate used for?
Different forms of fluticasone propionate are used to treat different conditions.
Fluticasone propionate nasal spray
Fluticasone propionate is commonly used in the form of a spray that you use nasally (through your nose). It is approved by the FDA to treat perennial nonallergic rhinitis in adults and in children four years old or above. Perennial nonallergic rhinitis, also known as vasomotor rhinitis, is characterized by inflammation inside your nose that is not caused by allergies. The anti-inflammatory properties of fluticasone propionate make it an effective treatment.
Fluticasone propionate nasal sprays can also be used to treat seasonal and perennial allergic rhinitis in adults and children four years old or above.
In 2017, a form of fluticasone propionate nasal spray that is delivered nasally by blowing into a mouthpiece attached to the bottle – sold under the brand name Xhance – was approved by the FDA for treating nasal polyps in adults aged 18 and above.
Fluticasone propionate oral inhalation
Fluticasone propionate can be inhaled when used as maintenance treatment for asthma in adults and children four years old and above. Inhaled fluticasone propionate comes in aerosol form (such as Flovent HPA) and dry powder form (such as Flovent Diskus).
In adults and children 12 years old and above, it may be combined with another drug, such as salmeterol, if fluticasone propionate is not effective alone. You can read more about this combination therapy in question 6: What is fluticasone/salmeterol?
Fluticasone propionate topical application
Fluticasone propionate is available in the form of a cream, lotion, or ointment, which is applied topically (directly onto the skin).
Topical fluticasone propionate is used to treat a variety of skin conditions characterized by inflammation, itching, and redness, including psoriasis, eczema, and irritation caused by allergens. Cream and lotion variants may be prescribed for adults and children three months old or above. However, it is usually used with caution in pediatric patients, often after a less potent corticosteroid has not had the desired effect.
Fluticasone propionate ointment is usually only prescribed to adults 18 years old and above.
How does fluticasone propionate work?
Fluticasone propionate is a synthetic corticosteroid, which mimics the actions of natural corticosteroids produced by your body. Natural corticosteroids are involved in several processes, including your immune response, inflammation, and metabolism.
Corticosteroids can be further categorized, with the main classes being glucocorticoids and mineralocorticoids. Glucocorticoids are the type of corticosteroids that influence your immune response and inflammation.
Fluticasone propionate is a glucocorticoid and therefore has anti-inflammatory effects. This is why you may see it referred to as both a corticosteroid and glucocorticoid.
The exact mechanisms of fluticasone propionate are not known, but it is believed to act on several chemicals connected to inflammation, which are histamine, prostaglandins, cytokines, tryptases, chemokines, and leukotrienes.
What are the side effects of fluticasone propionate?
Many of the side effects of fluticasone propionate are dependent on the form you take. You should speak to your doctor immediately if you experience any of the side effects listed below.
Fluticasone propionate nasal spray
- Bloody nose
- Dizziness
- Vision problems
- Fever
- Headache
- Tightness in your chest and/or trouble breathing
- Fast heart rate
- Unusual fatigue, tiredness, or weakness
- Pain, swelling, or puffiness around your eyes, face, or mouth
- Skin rash, irritation, itching, or hives
Fluticasone propionate oral inhalation
- White patches in your mouth and throat
- Diarrhea
- Vomiting
- Nausea
- Trouble swallowing
- Bone pain
- Vision problems or eye pain
- Lower abdominal or stomach pain
- Tightness in your chest and/or trouble breathing
- Pain, swelling, or puffiness around your eyes, face, or mouth
- Fast heart rate
- Growth reduction (in pediatric patients)
Fluticasone propionate topical application
- Burning, itching, redness, or stinging of the skin
- Skin rash or hives
- Dry skin
- Blurred vision
Effects of fluticasone propionate on the immune system
The way that fluticasone propionate works means it may reduce your immune system’s ability to fight infections. You should, therefore, be aware of any signs of infection and speak to your doctor if you experience symptoms such as fever, chills, a bad cough, or persistent sore throat. You should also speak to your doctor immediately if you are exposed to chickenpox or measles.
Speak to your doctor & read the label
This is not a comprehensive list of side effects that can occur when you take fluticasone propionate. Because fluticasone propionate comes in different forms and is prescribed at different dosages and for different lengths of time, it is important to both speak to your doctor about which side effects that you should be aware of. You should also read the leaflet that comes with your medication.
What is the difference between fluticasone propionate and fluticasone furoate?
Fluticasone can be described as the ‘steroidal backbone’ of both fluticasone propionate and fluticasone furoate. Propionate and furoate are called ester substituents, which are chemicals derived from acids. These ester substituents give fluticasone propionate and fluticasone furoate different chemical structures.
Many ester substituents, including those of other corticosteroids, are inactive and do not have an effect on the therapeutic properties of the drug. It is commonly assumed, therefore, that fluticasone is the active ingredient of both drugs. However, propionate and furoate are extremely stable and remain attached to the fluticasone structure during metabolism. This means they do influence the mechanisms of action and characteristics of the two drugs.
Studies have found that fluticasone furoate has superior traits, including a high molecular binding affinity and prolonged tissue retention. Such characteristics mean it is prescribed in lower doses than fluticasone propionate and is often taken once per day rather than twice, while still having similar therapeutic effects.
Fluticasone furoate is also approved for use in children as young as two years old, whereas fluticasone propionate is usually only prescribed in children four years old and above.
However, while fluticasone furoate has several benefits over fluticasone propionate, it is the newer of the two drugs and still under patent. Fluticasone furoate is, therefore, not available as a generic medication, meaning it is more expensive than fluticasone propionate.
Although the two drugs share a steroidal backbone and are widely used to treat the same conditions, they do have markedly different characteristics. However, the propensity among many – both healthcare professionals and patients – to use the word ‘fluticasone’ in isolation can cause confusion.
If you have any questions or concerns regarding your medication or require clarification regarding the form of fluticasone you are taking, you should speak to your doctor.
What is fluticasone/salmeterol?
Fluticasone/salmeterol (sold under the brand name Advair, among others) is a combination medication consisting of fluticasone propionate and salmeterol xinafoate. It is taken via inhalation and can be used as a maintenance treatment for asthma and COPD.
Salmeterol xinafoate belongs to a class of drugs called long-acting beta2-adrenergic agonists. Whereas corticosteroids reduce inflammation, salmeterol works by relaxing the muscles in the airways, helping prevent or reverse the tightening (bronchoconstriction) that leads to symptoms such as coughing, wheezing, and breathlessness.
Although salmeterol alone can be used to treat COPD, there is evidence that it increases the risk of asthma-related hospitalization and death when used as a standalone treatment for asthma. This risk has been shown to be mitigated when combined with an inhaled corticosteroid, such as fluticasone propionate.
Accordingly, the FDA suggests that salmeterol is only used to treat asthma “as an additional therapy for patients not adequately controlled on other asthma-controller medications (e.g., low- to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with two maintenance therapies.”
Fluticasone/salmeterol may be used to treat asthma in adults and children four years old and above; it is not used for patients whose asthma is well-controlled.
Is fluticasone propionate an antihistamine?
Fluticasone propionate is not an antihistamine. Antihistamines work by preventing the activity of histamine, a chemical your immune system releases when it detects a substance it deems harmful (including otherwise harmless allergens such as pollen and dust).
Synthetic corticosteroids, such as fluticasone propionate, work by mimicking the effects of natural corticosteroid hormones on your body. It is believed to act on several substances related to inflammation (including histamine). You can read more about how fluticasone propionate works in question 3: How does fluticasone propionate work?
Your doctor will consider the nature and severity of your symptoms when deciding whether to prescribe an antihistamine, a corticosteroid, or another type of medication (such as non-steroidal anti-inflammatory drugs or decongestants). In some cases, a combination therapy consisting of drugs in different classes may also be prescribed.
Is fluticasone propionate available over the counter?
In many countries, fluticasone propionate is available over the counter in the form of a nasal spray. Inhaled and topical forms (creams, lotions, ointments) usually require a prescription. However, this can vary in different markets.
Even if fluticasone propionate is available over the counter, it is important to follow the instructions on the label carefully. If you have any questions or concerns, or if the treatment is not effective, you should speak to your doctor or pharmacist.
Is fluticasone propionate suitable for children?
Fluticasone propionate is usually considered suitable for children, although the guidelines vary depending on the form in which it comes. To read about the FDA guidelines, go to question 2: What is fluticasone propionate used for?
Can you use fluticasone propionate when pregnant?
Under the FDA’s old coding system (in which drugs were classed as A, B, C, D, or X) for classifying the safety of drugs when used during pregnancy, most prescription products containing fluticasone propionate were class C. This meant that “animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”
Some products may still carry this categorization, but the coding system is being phased out and replaced with sections outlining more detailed risks summary and guidelines.
Regardless of the system used, labels for fluticasone propionate highlight that corticosteroids have been found to decrease fetal body weight and/or cause skeletal defects in animals when injected. Regarding inhaled fluticasone propionate, it has been found to decrease fetal body weight in rats when administered at a high dosage, but not when administered at a dosage equivalent to the maximum daily inhaled dosage recommended for humans. What’s more, other studies have found that rodents are more prone to these effects caused by corticosteroids than humans.
Nonetheless, the lack of adequate evidence from studies in pregnant humans means the potential risk to a fetus cannot be ruled out. In general, fluticasone propionate is not recommended during pregnancy unless the benefits are deemed to outweigh the risks. For example, in women with poorly or moderately controlled asthma there are known severe risks, including pre-eclampsia in the mother, and prematurity, low birth weight, and growth problems for the fetus. If fluticasone propionate is necessary in controlling asthma, therefore, it is likely to be deemed beneficial in order to mitigate these risks.
If you are pregnant or planning on getting pregnant, it is important to discuss every medication and supplement you take with your doctor, in order to find the safest solution for you and your baby.
The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.
