Generic Name

Flovent

Mechanism

• Glucocorticoid receptor activation: Intracellular uptake → translocation to the nucleus → binding to glucocorticoid response elements (GREs).
• Transrepression & transactivation: ↓ Pro‑inflammatory cytokines (IL‑4, IL‑5, IL‑13), ↑ anti‑inflammatory proteins (IL‑1 receptor antagonist, lipocortin‑1).
• ↓ Leukocyte migration to bronchial mucosa, ↓ mast cell degranulation, ↓ smooth‑muscle hyperplasia.
• Result: ↓ airway hyperresponsiveness, mucus production, and bronchial edema.

Pharmacokinetics

• Absorption: Delivered via dry powder; systemic absorption ≈ 3–8 % of a single dose.
• Distribution: Widely distributed; plasma protein binding > 99 %.
• Metabolism: Hepatic CYP3A4 → inactive metabolites.
• Excretion: Urine and feces; elimination half‑life 7–8 h for plasma, but pulmonary residence > 12 h.
• Drug interactions: CYP3A4 inhibitors (ketoconazole, ritonavir) increase systemic exposure; concurrent oral steroids potentiate adrenal suppression.

Indications

• Asthma – Maintenance therapy (daily prophylaxis).
• COPD – Reliever of exacerbations when combined with long‑acting β₂‑agonists (LABAs).
• Allergic rhinitis & nasal polyposis – Off‑label use in some jurisdictions.

Contraindications

• Absolute contraindications:
• Known hypersensitivity to fluticasone or any component.
• Active systemic infection requiring oral steroids.
• Warnings:
• Potential for adrenal suppression (≥ 2 % systemic exposure).
• Osteoporosis, cataracts, and growth retardation in pediatric patients.
• Susceptibility to oral thrush; maintain oral hygiene.
• Precautions:
• Use at lowest effective dose.
• Avoid in patients on potent CYP3A4 inhibitors unless dose adjustment is guided.

Dosing

• Technique – Exhale fully, place inhaler mouthpiece in mouth, inhale slowly while activating device, hold breath 5 s.
• Spacer use – Reduces oropharyngeal deposition, beneficial for children and patients with coordination issues.
• Reconstitution – Not required; pre‑filled dry powder device.

Adverse Effects

• Common
• Oral candidiasis (hoarseness, taste alteration)
• Dysphonia, cough, sore throat
• Nasal irritation (if using nasal spray)
• Serious
• Systemic corticosteroid effects: adrenal suppression, glucose intolerance, osteoporosis.
• Growth retardation (pediatric) – monitor height/weight annually.
• Rare: Angioedema, severe allergic reaction.

Monitoring

• Pulmonary function – Peak expiratory flow (PEF) or FEV₁ every 6 – 12 weeks.
• Growth metrics (children) – Height percentile tracking.
• Adrenal axis – Dexamethasone suppression test if systemic exposure suspected.
• Bone density – Baseline DEXA scan for chronic high‑dose users > 5 yr.
• Oral hygiene – Daily mouthwash or fluoride rinse; check for thrush.

Clinical Pearls

• Dry‑powder advantage – Faster onset, less throat irritation than nebulized or metered‑dose solutions.
• Avoid oral steroids unless needed – Use Flovent first to reduce systemic burden.
• Spacer is key for kids – Improves dose delivery to the lungs and reduces dysphonia.
• Low‑dose strategy – Start 100 µg BID in children; many achieve control at ≤ 200 µg/day.
• Monitoring growth – Even moderate doses show transient catch‑up; severe growth delay is rare with proper dosing.
• When using CYP3A4 inhibitors – Consider 300 µg/day if patient requires a strong inhibitor; monitor for adrenal signs.
• Post‑inhalation rinsing – Rinse mouth with water after each dose to mitigate thrush.
• Use same device – Switching between inhalers frequently impairs technique and therapeutic efficacy.

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• *Flovent* remains the cornerstone of inhaled corticosteroid therapy for asthma and COPD control. Proper dosing, vigilant monitoring, and patient education are essential to maximize benefit and minimize adverse events.