FLIXOTIDE™ Inhaler™
Fluticasone propionate Inhaler (CFC-Free) (50, 125 or 250 micrograms per actuation).
Qualitative and Quantitative Composition
FLIXOTIDE 50 Inhaler is a pressurised metered-dose inhaler which delivers 50mcg of fluticasone propionate per actuation into the mouthpiece of a specially designed actuator. Each canister supplies 120 actuations.
FLIXOTIDE 125 Inhaler is a pressurised metered-dose inhaler which delivers 125mcg of fluticasone propionate per actuation into the mouthpiece of a specially designed actuator. Each canister supplies 120 actuations.
FLIXOTIDE 250 Inhaler is a pressurised metered-dose inhaler which delivers 250mcg of fluticasone propionate per actuation. Each canister supplies 120 actuations.
Pharmaceutical Form
Pressurised metered-dose aerosol.
Clinical Particulars
Therapeutic Indications
Asthma:-
Fluticasone propionate has a marked anti-inflammatory effect in the lungs.
It reduces symptoms and exacerbations of asthma in patients previously treated with bronchodilator alone or with other prophylactic therapy.
Severe asthma requires regular medical assessment as death may occur. Patients with severe asthma have constant symptoms and frequent exacerbations, with limited physical capacity, and PEF values below 60% predicted at baseline with greater than 30% variability, usually not returning entirely to normal after a bronchodilator. These patients will require high dose inhaled (see dosage instructions) or oral corticosteroid therapy. Sudden worsening of symptoms may require increased corticosteroid dosage which should be administered under urgent medical supervision.
Adults:-
Prophylactic management in:-.
Mild asthma (PEF values greater than 80% predicted at baseline with less than 20% variability): Patients requiring intermittent symptomatic bronchodilator asthma medication on more than an occasional basis.
Moderate asthma (PEF values 60-80% predicted at baseline with 20-30% variability): Patients requiring regular asthma medication and patients with unstable or worsening asthma on currently available prophylactic therapy or bronchodilator alone.
Severe asthma (PEF values less than 60% predicted at baseline with greater than 30% variability): Patients with severe chronic asthma. On introduction of inhaled fluticasone propionate many patients who are dependent on systemic corticosteroids for adequate control of symptoms may be able to reduce significantly or to eliminate their requirement for oral corticosteroids.
Children:-
Any child who requires preventive asthma medication, including patients not controlled on currently available prophylactic medication.
Posology and Method of Administration
FLIXOTIDE Inhaler (CFC-Free) is for oral inhalation only.
The diagnosis and treatment of asthma should be kept under regular review.
Patients should be made aware of the prophylactic nature of therapy with inhaled fluticasone propionate and that it should be taken regularly even when they are asymptomatic. The onset of therapeutic effect is 4 to 7 days, although some benefit may be apparent as soon as 24 hours for patients who have not previously received inhaled steroids.
The dosage of fluticasone propionate should be adjusted according to the individual response.
If patients find that relief with short-acting bronchodilator treatment becomes less effective or they need more inhalations than usual, medical attention must be sought.
It is intended that each prescribed dose is given by a minimum of 2 inhalations.
In patients who find co-ordination of a pressurised metered dose inhaler difficult, a Volumatic™ spacer may be used with FLIXOTIDE Inhaler (CFC-Free).
Asthma:
Adults and children over 16 years of age:
100 to 1000mcg twice daily.
Patients should be given a starting dose of inhaled fluticasone propionate which is appropriate for the severity of their disease:-
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Mild asthma: |
100 to 250mcg twice daily. |
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Moderate asthma: |
250 to 500mcg twice daily. |
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Severe asthma: |
500 to 1000mcg twice daily. |
The dose may then be adjusted until control is achieved or reduced to the minimum effective dose, according to the individual response.
Alternatively, the starting dose of fluticasone propionate may be gauged at half the total daily dose of beclomethasone dipropionate or equivalent as administered by metered-dose inhaler.
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Children over 4 years of age: |
50 to 200mcg twice daily. |
Many children's asthma will be well controlled using the 50 to 100mcg twice daily dosing regime. For those patients whose asthma is not sufficiently controlled, additional benefit may be obtained by increasing the dose up to 200mcg twice daily.
Children should be given a starting dose of inhaled fluticasone propionate which is appropriate for the severity of their disease.
The dose may then be adjusted until control is achieved, or reduced to the minimum effective dose, according to the individual response.
This presentation of fluticasone propionate may not offer the required paediatric dose, in which case an alternative presentation of fluticasone propionate should be considered (e.g. dry powder inhalers).
Children aged 1 to 4 years:
- 100mcg twice daily administered via a paediatric spacer device with a face mask.
Inhaled fluticasone propionate is of benefit to younger children in the control of frequent and persistent asthma symptoms.
Clinical trials in 1 to 4 year old children have shown that the optimal control of asthma symptoms is achieved with 100mcg twice daily. Higher doses of inhaled fluticasone propionate are required in younger children compared to older children because of reduced efficiency of drug delivery due to smaller airways, use of a spacer device and increased nasal breathing.
Special patient groups:-
There is no need to adjust the dose in elderly patients or in those with hepatic or renal impairment.
Contra-indications
Hypersensitivity to any ingredient of the preparation.
Special Warnings and Special Precautions for Use
The management of asthma should follow a stepwise programme, and patient response should be monitored clinically and by lung function tests.
Increasing use of short-acting inhaled β
2-agonists to control asthma symptoms indicates deterioration of asthma control. Under these conditions, the patient's therapy plan should be reassessed. Sudden and progressive deterioration in asthma control is potentially life-threatening and consideration should be given to increasing corticosteroid dosage. In patients considered at risk, daily peak flow monitoring may be instituted.
FLIXOTIDE Inhaler (CFC-Free) is not for use in acute asthma attacks, but for routine long-term management. Patients will require a fast- and short-acting inhaled bronchodilator to relieve acute asthmatic symptoms.
Lack of response or severe exacerbations of asthma should be treated by increasing the dose of inhaled fluticasone propionate and, if necessary, by giving a systemic steroid and/or an antibiotic if there is an infection.
Patients' inhaler technique should be checked to make sure that inhaler actuation is synchronised with inspiration to ensure optimum delivery of the medicine to the lungs.
Systemic effects may occur with any inhaled corticosteroid, particularly at high doses prescribed for long periods; these effects are much less likely to occur than with oral corticosteroids. Possible systemic effects include adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma. It is important, therefore, that the dose of inhaled corticosteroid is titrated to the lowest dose at which effective control is maintained (see Undesirable Effects).
It is recommended that the height of children receiving prolonged treatment with inhaled corticosteroid is regularly monitored.
Certain individuals can show greater susceptibility to the effects of inhaled corticosteroid than do most patients.
Adrenal function and adrenal reserve usually remain within the normal range on recommended doses of fluticasone propionate therapy. The benefits of inhaled fluticasone propionate therapy should minimise the need for oral steroids. However, the possibility of adverse effects in patients, resulting from prior or intermittent administration of oral steroids, may persist for some time. The extent of the adrenal impairment may require specialist advice before elective procedures.
The possibility of impaired adrenal response should always be borne in mind in emergency and elective situations likely to produce stress and appropriate corticosteroid treatment must be considered.
Because of the possibility of impaired adrenal response, patients transferring from oral steroid therapy to inhaled fluticasone propionate therapy should be treated with special care, and adrenocortical function regularly monitored.
Following introduction of inhaled fluticasone propionate, withdrawal of systemic therapy should be gradual and patients encouraged to carry a steroid warning card indicating the possible need for additional therapy in times of stress.
In rare cases inhaled therapy may unmask underlying eosinophilic conditions (e.g. Churg Strauss syndrome). These cases have usually been associated with reduction or withdrawal of oral corticosteroid therapy. A direct causal relationship has not been established.
Similarly replacement of systemic steroid treatment with inhaled therapy may unmask allergies such as allergic rhinitis or eczema previously controlled by the systemic drug. These allergies should be symptomatically treated with antihistamine and/or topical preparations, including topical steroids.
Treatment with FLIXOTIDE Inhaler (CFC-Free) should not be stopped abruptly.
As with all inhaled corticosteroids, special care is necessary in patients with active or quiescent pulmonary tuberculosis.
Candidiasis of the mouth and throat (thrush) occurs in some patients. Such patients may find it helpful to rinse out their mouth with water after using the inhaler. Symptomatic candidiasis can be treated with topical anti-fungal therapy whilst still continuing with the FLIXOTIDE Inhaler (CFC-Free).
In some patients inhaled fluticasone propionate may cause hoarseness. It may be helpful to rinse out the mouth with water immediately after inhalation.
As with other inhalation therapy, paradoxical bronchospasm may occur with an immediate increase in wheezing after dosing. This should be treated immediately with a fast-acting inhaled bronchodilator. FLIXOTIDE Inhaler (CFC-Free) should be discontinued immediately, the patient assessed, and if necessary alternative therapy instituted.
Cutaneous hypersensitivity reactions have been reported.
Rare cases of facial and oropharyngeal oedema have been reported.
Possible systemic effects include adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma. (see Special Warnings and Special Precautions for Use).
