Wixela Inhub
Wixela Inhub
Generic Name
Wixela Inhub
Mechanism
- Glucocorticoid Receptor Agonist – FP binds intracellular glucocorticoid receptors (GR) in airway epithelial and immune cells.
- Transcriptional Regulation – The FP‑GR complex translocates to the nucleus, modulating gene expression:
- ↓ Pro‑inflammatory cytokines (IL‑5, IL‑13, TNF‑α)
- ↑ Anti‑inflammatory proteins (IL‑10, annexin‑1)
- Local Anti‑Inflammatory Effect – Reduces airway edema, mucus hypersecretion, and airway hyperresponsiveness.
- Minimal Systemic Exposure – High first‑pass hepatic metabolism limits systemic glucocorticoid effects.
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Pharmacokinetics
| Parameter | Value (Typical) |
| Absorption | Inhaled FP is absorbed via pulmonary mucosa; peak plasma concentration ~0.5 h. |
| Distribution | Protein‑bound (~99 %); limited systemic penetration. |
| Metabolism | Extensive first‑pass hepatic oxidation to inactive metabolites (e.g., 6‑OH‑FP). |
| Half‑Life | Apparent elimination half‑life ~7–12 h (lung residence ~4 h). |
| Excretion | Renal (~70 %) and biliary (~20 %). |
| Drug Interactions | CYP3A4 inhibitors (e.g., ketoconazole) may modestly increase plasma FP, but clinical relevance is minimal due to low systemic exposure. |
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Indications
- Asthma (Maintenance)
- *Adults & adolescents ≥12 y*: 250 µg BID (total 500 µg/day).
- *Children 6–11 y*: 125 µg BID (total 250 µg/day).
- Chronic Obstructive Pulmonary Disease (Maintenance)
- *Adults*: 250 µg BID (total 500 µg/day) for COPD exacerbation prevention.
*Note*: Doses are per *fluticasone propionate* content; the Inhub device delivers the powder in a single actuation per dose.
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Dosing
| Condition | Typical Dose | Frequency | Device Notes |
| Asthma | 250 µg (1 actuation) | BID | Use with or without spacer. |
| COPD | 250 µg (1 actuation) | BID | Recommended for maintenance only; not for rescue. |
Adverse Effects
| Category | Examples |
| Local (Common) | Oral candidiasis, dysphonia, cough, sore throat, throat irritation. |
| Systemic (Rare/Serious) | Adrenal suppression, osteoporosis, cataracts, growth suppression (pediatric). |
| Special Populations | ↑ infection risk in COPD; caution in pregnancy (category B). |
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Monitoring
- Pulmonary Function – FEV₁, peak expiratory flow (PEF) every 4–6 weeks.
- Lung Infections – Evaluate for pneumonia; consider chest imaging if respiratory decline.
- Bone Health – DEXA scan in long‑term users >10 years or with risk factors.
- Growth – For pediatric patients, assess height/weight velocity quarterly.
- Serum Cortisol – If signs of adrenal suppression (fatigue, hypotension) appear.
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Clinical Pearls
- Use a Spacer: Improves drug deposition in lower airways and decreases oral thrush, especially in children or patients with coordination difficulties.
- Rinse After Use: Swish with water and spit within 30 s to remove residual FP from oral mucosa.
- Dose Adjustment for COPD: If patients remain symptomatic, consider adding a LABA or LAMA; FP alone rarely provides adequate bronchodilation.
- Adherence Check: Verify inhaler technique at each visit; incorrect inhalation accounts for ~30 % of non‑response.
- Drug Interactions: Although systemic exposure is low, concurrent use of potent CYP3A4 inhibitors (e.g., itraconazole) may modestly raise plasma FP; monitor for systemic signs if clinically warranted.
- Vaccination: COPD patients on inhaled steroids should receive annual influenza and pneumococcal vaccines to mitigate infection risk.
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• Key Takeaway
*Wixela Inhub* delivers *fluticasone propionate* efficiently to the lower airways, providing anti‑inflammatory control in asthma and COPD while minimizing systemic exposure. Mastering inhalation technique and vigilant monitoring are essential to maximize therapeutic benefit and minimize adverse effects.