Fluticasone + Formoterol


Concise Prescribing Info
Indications/Uses
Asthma.
Dosage/Direction for Use
Adult : Inhalation Each actuation of metered-dose inhaler releases fluticasone (mcg)/formoterol (mcg): 50/5, 125/5 or 250/10: Initial: 2 puffs bid , titrated to the lowest effective dose and may be increased by switching to next highest strength combination, depending on patient’s response.
Dosage Details
Inhalation/Respiratory
Asthma
Adult: Available preparations:
Metered-dose inhaler releasing fluticasone 50 mcg and formoterol 5 mcg per actuation
Metered-dose inhaler releasing fluticasone 125 mcg and formoterol 5 mcg per actuation
Metered-dose inhaler releasing fluticasone 250 mcg and formoterol 10 mcg per actuation
Initially, 2 puffs bid, titrated to the lowest effective dose and may be increased by switching to next highest strength combination, depending on patient’s response.
Child: Available preparations:
Metered-dose inhaler releasing fluticasone 50 mcg and formoterol 5 mcg per actuation
Metered-dose inhaler releasing fluticasone 125 mcg and formoterol 5 mcg per actuation
≥12 yr Same as adult dose.
Special Precautions
Patient w/ active or quiescent pulmonary TB, untreated systemic infections, ocular herpes simplex, or w/ fungal, viral or airway infections, thyrotoxicosis, phaeochromocytoma, DM, hypokalaemia, CV disorders (e.g. arrhythmia, heart failure, hypertrophic obstructive cardiomyopathy, idiopathic subvalvular aortic stenosis, severe HTN, aneurysm). Not intended for acute asthma attack. Hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Hypokalaemia, paradoxical bronchospasm, increased wheezing, shortness of breath, QTc interval prolongation.
Nervous: Insomnia, headache, tremor, dizziness, abnormal dreams, agitation, asthenia.
CV: Palpitations, ventricular extrasystoles, angina pectoris, tachycardia, HTN, peripheral oedema.
GI: Oral candidiasis/fungal infections, hoarseness, stomatitis, dry mouth, diarrhoea, dyspepsia, nausea.
Resp: Asthma exacerbation, dysphonia, throat irritation, sinusitis.
Endocrine: Hyperglycaemia, increased blood lactate levels, decrease BMD.
Ophthalmologic: Cataract/glaucoma.
Dermatologic: Rash, pruritus, contusion, skin atrophy.
Immunologic: Anaphylaxis reactions.
Potentially Fatal: Arrhythmia, cardiac arrest.
Patient Counseling Information
Rinse mouth thoroughly every after inhalation. Avoid abrupt withdrawal.
MonitoringParameters
Perform FEV1, peak flow, and/or other pulmonary function tests. Monitor serum K, BMD level, BP, hepatic function, hypothalamic-pituitary-adrenal (HPA) axis suppression/adrenal insufficiency, ocular changes, signs of asthma deterioration, growth degradation, and symptom relief.
Overdosage
Symptoms: Fluticasone: Adrenocortical suppression, headache, nausea, vomiting, hypotension, variable sugar level, seizures, HTN/hypotension. Management: Symptomatic and supportive treatment.
Drug Interactions
Fluticasone: Increased plasma concentration w/ CYP3A4 inhibitors (e.g. ketoconazole, HIV protease inhibitors, clarithromycin, ketoconazole). Formoterol: May induce hypokalaemia w/ xanthine derivatives, steroids and diuretics. Increased risk of ventricular arrhythmias w/ digitalis glycoside, halogenated hydrocarbon anaesthetics. May prolong QTc-interval w/ TCAs, MAOIs, antipsyschotics, quinidine, disopyramide, procainamide, and antihistamines. Reduced therapeutic effect w/ β-blockers. May impair cardiac tolerance w/ L-dopa, L-thyroxine, oxytocin.
Food Interaction
May impair cardiac tolerance w/ alcohol.
Action
Description: Fluticasone is a corticosteroid w/ glucocorticoid activity. It utilises a fluorocarbothioate ester linkage at the 17 carbon position. It has potent vasoconstrictive and anti-inflammatory activity hence, reduces the symptoms, improves lung function and prevents asthma exacerbation.
Formoterol is a long-acting selective β2 adrenoceptor agonist. It relaxes bronchial smooth muscles by stimulation of adenyl cyclase, thereby increasing cyclic-3’-5’-adenosine monophosphate (cAMP) levels.
Onset: Formoterol: W/in 3 min.
Duration: Formoterol: 12 hr.
Pharmacokinetics:
Absorption: Fluticasone: Absorbed systemically primarily via lungs. Bioavailability: 13.9%. Time to peak plasma concentration: 0.5-1 hr.
Formoterol: Rapidly absorbed into plasma.
Distribution: Fluticasone: Extensively distributed in the body. Volume of distribution: 4.2 L/kg. Plasma protein binding: Approx 91%.
Formoterol: Plasma protein binding: 61-64% (34% primarily to albumin).
Metabolism: Fluticasone: Undergoes extensive hepatic first-pass metabolism, converted to 17β-carboxylic acid by CYP3A4 isoenzyme.
Formoterol: Metabolised via glucuronidation and O-demethylation to inactive O-demethylated glucuronate conjugate and deformylated metabolites.
Excretion: Fluticasone: Mainly via faeces (75% as parent compound and metabolites); urine (<5% as metabolites). Terminal elimination half-life: Approx 8 hr.
Formoterol: Mainly via urine (15-18% as glucuronide metabolite; 2-10% as unchanged drug). Terminal elimination half-life: Approx 10-14 hr.
Chemical Structure

Chemical Structure Image
Fluticasone propionate

Source: National Center for Biotechnology Information. PubChem Database. Fluticasone propionate, CID=444036, https://pubchem.ncbi.nlm.nih.gov/compound/Fluticasone-propionate (accessed on Jan. 21, 2020)


Chemical Structure Image
Formoterol

Source: National Center for Biotechnology Information. PubChem Database. Arformoterol, CID=3083544, https://pubchem.ncbi.nlm.nih.gov/compound/Arformoterol (accessed on Jan. 21, 2020)

Storage
Store below 25°C.
ATC Classification
R03AK11 - formoterol and fluticasone ; Belongs to the class of adrenergics in combination with corticosteroids or other drugs, excluding anticholinergics. Used in the treatment of obstructive airway diseases.
References
Anon. Fluticasone (Oral Inhalation). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/09/2017.

Anon. Formoterol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/09/2017.

Buckingham R (ed). Fluticasone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/09/2017.

Joint Formulary Committee. Fluticasone with Formoterol. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/09/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Fluticasone Propionate (EENT). AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 04/09/2017.

Disclaimer: This information is independently developed by MIMS based on Fluticasone + Formoterol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
  • Flutiform
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in