Names and pronunciation
(floo′ta-mide)
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Drug reference
(floo′ta-mide)
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Func. class.: Antineoplastic, hormone Func. class.: Steroidal anti-inflamma- tory, antiasthmatic
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Chem. class.: Antiandrogen Chem. class.: Corticosteroid
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ACTION: Interferes with androgen uptake in the nucleus or androgen activ- ity in target tissues; arrests tumor growth in androgen-sensitive tissue (i.e., pros- tate gland) ACTION: Decreases inflammation by inhibiting mast cells, macrophages, and leukotrienes; antiinflammatory and vaso- constrictor properties
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USES: Metastatic prostatic carci- noma, stage D2 in combination with LHRH agonistic analogs (leuprolide), B2-C in combination with goserelin and radiation USES: Prevention of chronic asthma during maintenance treatment in those requiring oral corticosteroids; nasal symptoms of seasonal/perennial, aller- gic/nonallergic rhinitis
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Do not confuse: Flonase/Flovent
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CONTRAINDICATIONS: Preg- nancy, hypersensitivity CONTRAINDICATIONS: Hyper- sensitivity to this product or milk protein, primary treatment in status asthmaticus, acute bronchospasm Precautions: Pregnancy, breastfeeding, active infections, glaucoma, diabetes, immunocompromised patients, Cushing syndrome
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Black Box Warning: Severe hepatic disease Precautions: G6PD deficiency, hemo- globinopathy, lactase deficiency, poly- cystic ovary syndrome, tobacco smoking Black Box Warning: Severe hepatic dis- ease: Monitor before start of therapy and monthly × 4 mo, AST, ALT, alk phos, which may be elevated; if LFTs elevated, prod- uct may need to be discontinued; monitor CBC, bilirubin, creatinine periodically • CNS symptoms, including drowsiness, confusion, depression, anxiety Black Box Warning: Hepatotoxicity: to report nausea, vomiting, yellow eyes or skin, dark urine, clay-colored stools; hepatotoxicity may be the cause • Notify of yellow, green urine discoloration • Avoid sun exposure, tanning beds • To use contraception during treatment; pregnancy category • To use with full glass of water, without regard to food (floo-tic′a-sone) Arnuity, Ellipta, Flonase, Flovent Diskus, Flovent HFA
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SIDE EFFECTS CNS: Hot flashes, drowsiness, confusion, depression, anxiety, paresthesia GI: Diarrhea, nausea, vomiting, increased levels in hepatic studies, hepatitis, anorexia, hepatotoxicity, abdominal pain, cholestasis, hepatic necrosis/failure hepatic necro- sis/failure GU: Decreased libido, impotence, gynecomastia HEMA: Hemolytic anemia, leukopenia, thrombocytopenia INTEG: Irritation at site, rash, photosensitivity MISC: Edema, neuromuscular and pul- monary symptoms, hypertension, sec- ondary malignancy SIDE EFFECTS CNS: Fatigue, fever, headache, nervous- ness, dizziness, migraines EENT: Pharyngitis, sinusitis, rhinitis, lar- yngitis, hoarseness, dry eyes, cataracts, nasal discharge, epistaxis, blurred vision GI: Diarrhea, abdominal pain, nausea, vomiting, oral candidiasis INTEG: Urticaria, dermatitis META: Hyperglycemia, growth retarda- tion in children, cushingoid features MISC: Influenza, eosinophilic conditions, angioedema, Churg-Strauss syndrome, anaphylaxis, adrenal insufficiency (high doses), bone mineral density reduction MS: Osteoporosis, muscle soreness, joint pain, arthralgia RESP: Upper respiratory infection, dys- pnea, cough, bronchitis, bronchospasm
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INTERACTIONS Increase: PT—warfarin Decrease: flutamide action—LHRH ana- log (leuprolide) Drug/Lab Test Increase: LFTs, BUN, creatinine Decrease: WBC, platelets INTERACTIONS Increase: fluticasone levels—CYP3A4 inhibitors (ketoconazole, itraconazole), darunavir, nelfinavir, ritonavir, amprenavir, fosamprenavir, atazanavir, delavirdine, saquinavir Increase: cardiac toxicity—isoprotere- nol (asthma patients)
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DOSAGE AND ROUTES • Adult: PO 250 mg q8hr for a daily dos- age of 750 mg DOSAGE AND ROUTES Prevention of chronic asthma Flovent HFA • Adult/child ≥12 yr: INH 88-440 mcg bid (in those previously taking bron- chodilators alone); INH 88-220 mcg bid, max 440 mcg bid (in those previ- ously taking inhaled corticosteroids); INH 440 mcg bid, max 880 mcg bid (in those previously taking oral corticoste- roids) • Child 4-11 yr: INH 88 mcg bid Flovent Diskus • Adult/child ≥12 yr: INH 100 mcg bid, max 500 mcg bid (in those previously taking bronchodilators alone); INH 100- 250 mcg bid, max 500 mcg bid (in those previously taking inhaled corticoste- roids); INH 500-1000 mcg bid, max 1000 mcg bid (in those previously taking oral corticosteroids) • Child 4-11 yr: INH Initially 50 mcg bid, max 100 mcg bid (in those previously taking bronchodilators alone or inhaled corticosteroids) Arnuity Ellipta • Adult/child ≥12 yr: INH 100 mcg via oral inhalation daily initially; may increase to 200 mcg/day after 2 wk; max 200 mcg/day Seasonal, perennial allergic, nonal- lergic rhinitis Flonase • Adult: NASAL 2 sprays initially in each nostril daily or 1 spray bid; when con- trolled, lower to 1 spray in each nostril daily • Adolescent/child >4 yr: NASAL 1 spray in each nostril daily, may increase to 2 sprays in each nostril daily; when F controlled, lower to 1 spray in each nostril daily
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Available forms: Caps 125, 250 mg Available forms: Oral inhalation aerosol 44, 110, 220 mcg; oral inhala- tion powder 50, 100, 250 mcg; nasal spray 27.5 mcg/actuation, (propionate) 50 mcg/actuation, 27.5 mcg/spray (furoate); inhalation powder 100, 200 mcg/actuation (Arnuity Ellipta)
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Administer: • Do not break, crush, chew caps • Give without regard to food with a full glass of water • Use cytotoxic handling procedures Administer: • Give at 1-min intervals; if a bronchodi- lator aerosol spray is used, use broncho- dilator first, wait 5-15 min, then use fluticasone • Decrease dose to lowest effective dose after desired effect; decrease dose at 2-4 wk intervals Inhalation route (aerosol) • Shake well, prime before 1st use, release 4 sprays into air away from face, prime using 1 spray if not used for ≥7 days; when the counter reads 000, discard; clean mouthpiece daily in warm water, dry; do not share inhaler with others • Child <4 yr requires a face mask with spacer/VHC device for delivery; allow 3-5 INH per actuation; do not use spacer with Flovent Diskus Inhalation route: Powder for oral inhala- tion (Flovent Diskus) • Fill in the “Pouch opened” and “Use by” dates in the blank lines on the label; the “Use by” date for Flovent Diskus 50 mcg is 6 wk from the date the pouch is opened; the “Use by” date for Diskus 100 mcg and 250 mcg is 2 mo from the date the pouch is opened • After use, patient should rinse mouth with water and spit out the water, not swallow it • To avoid the spread of infection, do not use the inhaler for more than one person Intranasal • Prime before first use • Shake bottle gently before each use • Rinse tip after use, dry with tissue • Blow nose before use
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Assess: Assess: • Respiratory status: lung sounds, pul- monary function tests during, for several mo after change from systemic to inhala- tion corticosteroids • Withdrawal symptoms from oral corti- costeroids: depression, pain in joints, fatigue • Adrenal insufficiency: nausea, weak- ness, fatigue, hypotension, hypoglycemia, anorexia; may occur when changing from systemic to inhalation corticosteroids; may be life-threatening; adrenal func- tion tests periodically: hypothalamic– pituitary–adrenal axis suppression in long-term treatment • Growth rate in children; blood glucose, serum potassium for all patients • Beers: avoid use in older adults with delirium or at high risk of delirium; may worsen the condition • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; use caution in breastfeeding, excretion unknown
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Evaluate: • Therapeutic response: decrease in prostatic tumor size, decrease in spread of cancer Evaluate: • Therapeutic response: decreased se- verity of asthma, COPD, allergies
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CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report side effects: decreased li- bido, impotence, breast enlargement, hot flashes, diarrhea Patient and caregiver information: • To use bronchodilator 1st, before us- ing inhalation, if taking both • Not to use for acute asthmatic attack; acute asthma may require oral cortico- steroids • To avoid smoking, smoke-filled rooms, those with URIs, those not immunized against chickenpox or measles • To rinse mouth after inhaled product to decrease risk of oral candidiasis • To report immediately cushingoid symptoms: no appetite, nausea, weak- ness, fatigue, decreased B/P • How to use, and when it may be empty • To use medical ID identifying cortico- steroid use
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PHARMACOKINETICS Rapidly and completely absorbed; excreted in urine and feces as metabo- lites; half-life 6 hr, geriatric half-life 8 hr; 94% protein binding, peak 2 hr PHARMACOKINETICS Absorption 30% aerosol, 13.5% powder; protein binding 91%; metabolized in liver after absorption in lung; half-life 7.8 hr; <5% excreted in urine and feces Oral INH: Onset 24 hr, peak several days, duration 1-2 wk Intranasal: Onset 12 hr, peak several days
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• Adult: PO 250 mg q8hr for a daily dos- age of 750 mg DOSAGE AND ROUTES Prevention of chronic asthma Flovent HFA
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• Adult/child ≥12 yr: INH 88-440 mcg bid (in those previously taking bron- chodilators alone); INH 88-220 mcg bid, max 440 mcg bid (in those previ- ously taking inhaled corticosteroids); INH 440 mcg bid, max 880 mcg bid (in those previously taking oral corticoste- roids)
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• Adult/child ≥12 yr: INH 100 mcg bid, max 500 mcg bid (in those previously taking bronchodilators alone); INH 100- 250 mcg bid, max 500 mcg bid (in those previously taking inhaled corticoste- roids); INH 500-1000 mcg bid, max 1000 mcg bid (in those previously taking oral corticosteroids)
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• Adult/child ≥12 yr: INH 100 mcg via oral inhalation daily initially; may increase to 200 mcg/day after 2 wk; max 200 mcg/day Seasonal, perennial allergic, nonal- lergic rhinitis Flonase
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• Adult: NASAL 2 sprays initially in each nostril daily or 1 spray bid; when con- trolled, lower to 1 spray in each nostril daily
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