Fluticasone Propionate

Registered South African indications:

• Steroid-responsive dermatoses

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Untreated cutaneous infections
• Rosacea
• Acne vulgaris
• Perioral dermatitis
• Perianal and genital pruritus
• Pruritus without inflammation
• Dermatoses in infants under three months of age, including dermatitis and nappy rash

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Abrupt withdrawal
• Prolonged use
• Large surface area of application
• Use of occlusive dressing
• Thin skin areas such as the face
• Impaired skin barrier
• Psoriasis
• Use on eyelids
• Chronic leg ulcers

Forms avail. in SA and covered in this monograph: cre, oin

Atopic dermatitis
Nummular dermatitis
Prurigo nodularis
Psoriasis
Lichen simplex chronicus
Lichen planus
Seborrhoeic dermatitis
Irritant dermatitis
Allergic contact dermatitis
Discoid lupus erythematosus
An adjunct to systemic steroid therapy in generalised erythroderma
Miliaria
Insect bite reactions

• Topical (cre, oin): Apply small quantity to the affected area, 12-24hrly; Max duration: 4 weeks

See link: General prescribing points for steroids

Use until improvement occurs then reduce frequency or change to less potent preparation

An emollient should be continued as part of maintenance therapy

Allow adequate time for absorption after application before applying emollient

Paed. forms avail. in SA and covered in this monograph: cre, oin

Atopic dermatitis
Nummular Dermatitis
Prurigo nodularis
Psoriasis
Lichen simplex chronicus
Lichen planus
Seborrhoeic dermatitis
Irritant dermatitis
Allergic contact dermatitis
Discoid lupus erythematosus
An adjunct to systemic steroid therapy in generalised erythroderma
Miliaria
Insect bite reactions

Younger than 3 months

• Not established for use  

Older than 3 months

• See adult dosage

See link: General prescribing points for steroids

Ensure the amount applied is the minimum that provides therapeutic benefit

Children generally require shorter courses and less potent agents than adults

Allow adequate time for absorption after application before applying emollient

Pregnancy

• Caution
• Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development. The relevance of this finding to human beings has not been established; however, administration of fluticasone propionate during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus

Breastfeeding

• Caution
• The excretion of fluticasone propionate into human breast milk has not been investigated. When measurable plasma levels were obtained in lactating laboratory rats following subcutaneous administration there was evidence of fluticasone propionate in the milk. However, plasma levels in patients following dermal application of fluticasone propionate at recommended doses are likely to be low

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Cardiovascular Disorders 

• Hypertension

Endocrine and Metabolic Disorders

• Increased weight 
• Growth suppression (children)

Musculoskeletal Disorders

• Osteoporosis

Skin and Subcutaneous Tissue Disorders

• Pruritis
• Skin thinning
• Atrophy
• Striae
• Telangiectasias
• Pigmentation changes
• Hypertrichosis
• Allergic contact dermatitis
• Exacerbation of underlying symptoms
• Pustular psoriasis
• Erythema
• Urticaria

Immune, Blood and Lymphatic System Disorders

• Opportunistic infection
• Hypersensitivity
• Cushingoid features
• Decreased endogenous cortisol levels
• Hyperglycaemia/glucosuria

Sensory Disorders

• Cataract
• Glaucoma

• CYP3A4 inhibitors

None routine

Topical fluticasone has anti-inflammatory, antipruritic and vasoconstrictive properties. It acts as an anti-inflammatory agent via multiple mechanisms to inhibit late phase allergic reactions including decreasing the density of mast cells, decreasing chemotaxis and activation of eosinophils, decreasing cytokine production by lymphocytes, monocytes, mast cells and eosinophils, and inhibiting the metabolism of arachidonic acid.

Cream (per 100g) 0.05g

• Cutivate (GSK) originator

Ointment (per 100g) 0.005g

• Cutivate (GSK) originator

Also available in the following forms: Inhaler, accuhaler, nasules and nasal spray.