Asthma prevalence is relatively high in the United States afflicting every 13th person. Among the various treatment options presently available for managing the condition, glucocorticoids are known to be effective options. Following subsections offer an in-depth view of one such formulation, including possible fluticasone propionate side effects. This will help users identify symptoms of undesirable effects, and take suitable remedial measures, in addition to preventing the condition from worsening.  

Overview of Fluticasone propionate

Belonging to the category of glucocorticoids, fluticasone propionate is also used in treating inflammatory skin conditions, in addition to asthma and non-allergic rhinitis. The medication comes in the form of inhalers, sprays and topical applications, depending on the condition being treated. In use for more than 3 decades since approval, the medication is one among the popular formulations. The mechanism of action of the medication is not exactly known, though it delivers outcomes by the impact on cell types and by reducing inflammation. Laboratory tests on rats, have determined that the drug exerts inhibitory properties on eosinophilia in the lungs.

Available formulations

The medication is presently available in different formulations including topical creams and ointments, that are typically used to manage inflammation in the skin. It is also used to manage the itching that may be experienced with skin conditions. The product is also available as a nasal spray, that is used in the treatment of allergic rhinitis. Patients with the condition end up with soft and inflamed nose, due to inhalation of allergens. The spray containing fluticasone propionate brings down the inflammation in the nose and offers relief.

The drug is also available as an inhaler, and is used in the treatment of asthma. Common symptoms that may be experienced by asthmatic patients are difficulty in breathing, a distinct tight feeling in the chest, and bouts of wheezing. Coughing may also be experienced by patients with asthma. The inhaler containing the formulation reduces the inflammation, and permits easy movement of air to and from the lungs.

Commonly reported fluticasone propionate side effects

All medications come with the probability of undesirable effects and fluticasone propionate is not an exception. The undesirable outcomes may be broadly classified into mild effects and strong effects. The mild effects are more frequently occurring in nature, while the strong effects occur relatively rarely. Outcomes that are not strong may not require any medical intervention to resolve, and may most likely wear off naturally in a few days. The serious effects, may however, require some kind of intervention, depending on the type of effect and the intensity.

All users of medications may not experience effects, with a sizeable proportion of users remaining untouched by the effects. Here is a compilation of frequently occurring effects; it is added that this compilation is not exhaustive in nature and is intended to serve as a broad reference of the possible outcomes.

Mild effects that may be frequently reported

Effects that could be frequently reported or experienced include burning sensation, and possible itching when on the medication. Similarly, flushing of the skin and possible irritation may also be experienced as an effect. Other effects include outbreak of rashes, and a sudden, abnormal increase in growth of hair. A lightheaded feeling may also be experienced by patients on the medication, while some are known to experience thinning of the skin. The possibility of nosebleed also exists among individuals on the drug. Similarly, patients may experience throbbing headaches and may also have to put up with bouts of coughing. Unless persistent in nature, or intense, these effects may not always require attention, and are most likely to resolve naturally.

Effects that are regarded as a cause for concern

As outlined earlier, certain effects may be serious in nature and may require medical assistance. Some of the adverse side effects are shortness of breath, that is similar to that of aggravated asthma. Infections in the upper respiratory tract are a possibility, while some are known to experience symptoms of sinusitis. Apart from this, the patient may also experience inflammation in the upper respiratory tract, and bronchitis. Other possible outcomes that are a cause for concern include fungal infections that need to be treated at the earliest.

Drug interactions of fluticasone propionate

In addition to possible fluticasone propionate side effects, the formulation may also interact with other drugs. This is not restricted to prescription medication but may also occur with OTC products, herbal remedies, supplements and alternative medicines. The result of drug interactions can be broadly classified into three different types. The first outcome could be an increase in the potency or desired outcome of either of the two medications. The second could be a decrease in the potency or desired outcome of either of the two medications. The third could be an aggravation of the side effects of either or both the medications.

The typical course of action in the event of drug interactions, may include temporary discontinuation of one medication and possible change in medications. This is determined by assessing the importance of each of the two drugs, and changing/halting the one with the relatively lesser importance. In the event of both the drugs having equally important desired outcomes, the specialist may alter the dosage, or may stagger the timing of intake so as to minimize the impact. Here is a list of some of the products that may interact with fluticasone – this is not a complete list, and is only a reference of categories of products that may interact.

List of medications that interact with fluticasone propionate

Specific types of antibiotics are known to interact with the glucocorticoid, such as clarithromycin. Similarly, antifungal medications are also known to interact with the drug. This may complicate the course of treatment, as one of the side effects of the drug is fungal infections, and when the fungal infections are treated with antifungals, there could be interactions. It is necessary to choose antifungals that are not similar to itraconazole or ketoconazole.

HIV patients on antiretroviral medications may also experience the effects of drug interaction. Medications like atazanavir and ritonavir may interact with the glucocorticoid and this may make it necessary to choose suitable alternate medications, as both the conditions require treatment. The drug may also interact with certain antidepressants, and patients on medications or treatment are to intimate the treating specialist of the medicines and dosage.

Precautions by categories of patients

While the drug is regarded as relatively safe for most patients, it is not to be taken by pregnant women and mothers with suckling infants. Women who are planning a pregnancy or expectant mothers are to seek alternative medications and treatments to eliminate possible effects from the medicine. While the drug may have to be taken for a long time by a small section of users, this may sometimes turn into a problem for some. For instance, there are long term risks linked with the medication, including risk of exposure to infections.

Other risks that may arise from long term use includes complications in the adrenal glands. This risk is not specific to fluticasone propionate, but is common to all medications that belong to the corticosteroid category. Topical applications of the drug over an extended period are also known to expose the patient to the risk of suppressing the immune system. However, the silver lining of this effect is that this effect is reversible and nature, and patients who discontinue the medication may find the effects resolving.

Impact on vision

The medication could also expose the patient to risk of experiencing vision related problems. For instance, there is a possibility of ending up with cataract or glaucoma, as a result of extended use of nasal sprays or inhalers containing the glucocorticoid. Patients on the medication who experience any kind of symptoms related to vision are to seek evaluation at the earliest.

Instructions on dosage and overdose risks

As the medication is intended to be taken over an extended time, it is necessary to stick to dosage and schedule diligently. Ideally, the lowest effective dosage is to be identified and this should be diligently followed. While there is relatively lesser risk or probability of overdosing with topical applications, there is a risk of overdose with the inhaler and the nasal spray. A significant percentage of patients reporting side effects are due to overdosing.

This occurs when nasal sprays and inhalers are used, as patients and caregivers often consider the contents of sprays and inhalers as completely safe, when compared with oral medications or injections. Consequently, the urge to overdose either through a greater number of pumps or through increase in frequency results in intake of more than recommended dosage. Here is a short compilation of ideal dosage. This is only a reference, and the actual dosage will be determined by the specialist treating the patient.

When applied topically for inflamed skin conditions, it should be applied only on the infected area twice a day. A thin layer needs to be applied, and the individual is to wash hands properly with soap. Adults using the spray are to pump twice in each nostril; and this is to be done once daily. For children, this dose is to be reduced to just one spray in each nostril. The dosage when inhalers are used, is typically lesser than 90 micrograms, twice every day. It is to be noted that it is micrograms, and not milligrams, as patients often assume the volume to be milligrams. The abbreviation is mcg or ug, and caregivers/patients are to observe this with utmost care.

Absorption and bioavailability

The efficacy of medications is assessed in many ways, and one of the considerations is the bioavailability. Fluticasone propionate bioavailability is less than 2% when administered intranasally, and when administered orally, it is less than 1%. When given to a patient intranasally, a significant percentage of the dose ends up being swallowed. When administered topically, the absorption is relatively lower, but this depends on various factors including the type of skin condition being treated and the type of skin. These factors have an impact on the dosage and the outcomes of medications, and it is therefore necessary to diligently follow all dosage instructions.

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