1639 Nasal polyps. For discussion of the value of corticoster­ porphyrinogenic; it may be used as a drug of first choice Seretide; Thai.: Seretide; Seroflo; Turk.: Respiro; Seretide; UK: oids in the treatment of nasal polyps, including reference and no precautions are needed.1 Dymista; flutiform; Relvar Ellipta; Seretide; Ukr.: Seretide (CeperH,U); USA: Advair; Breo Ellipta; Dymista; Venez.: Seretide. to the use of fluticasone, see p. 1608.2. 1. The Drug Database for Acute Porphyria. Available at; http:l/www. drugs·porphyria.org (accessed 17/10/ll) Pharmacopoeial Prepara�ons Rhinitis. For a discussion of the management of rhinitis, BP 2014: Fluticasone Cream; Fluticasone Inhalation Powder, including the use of corticosteroids, see p. 612.1. Some Interactions 1 pre-dispensed; Fluticasone Inhalation Powder; Fluticasone Nasal further references to the use of fluticasone in rhinitis are The interactions of corticosteroids in general are described Drops; Fluticasone Nasal Spray; Fluticasone Ointment; Flutica­ given below. on p. 16!9.3. sone Pressurised Inhalation; 1. Wiseman LR, Benfield P. Intranasal fluticasone propionate: a reappraisal USP 36: Fluticasone Propionate Cream; Fluticasone Propionate of its pharmacology and clinical efficacy in the treatment of rhinitis. Inhalation Aerosol; Fluticasone Propionate Inhalation Powder; Drugs 1997; 53: 885-907. Pharmacokinetics Fluticasone Propionate Nasal Spray; Fluticasone Propionate 2. McCormack PL, Scott LJ.Fluticasone furoate: intranasal use in allergic Ointment. rhinitis. Drugs 2007; 67: 1905-15. For a brief outline of the pharmacokinetics of corticoster­ oids, see p. 1620.3. Fluticasone propionate is poorly absorbed from the Adverse Effects, Treatment, Withdrawal, and gastrointestinal tract and undergoes extensive first-pass Halcinonide (BAN. USAN, r/NN) @ Precautions metabolism; oral bioavailability is reported to be only about 1%. As for corticosteroids in general (see p. 1615.3, p. 1618.1, References. and p. 1618.3, respectively). Hypersensitivity reactions have I. Mackie AE, et al. Pharmacokinetics of intravenous fluticasone occurred with fluticasone. Eosinophilic conditions, includ­ 41: propionate in healthy subjects. Br 1 Clin Pharmacal 1996; 539-42. ing Churg-Strauss syndrome, have been reported rarely, in 2. van Boxte\ CJ, Sheffer AL, eds. The pharmacokinetics of fluticasone most cases after a tra_nsfer from oral corticosteroid therapy. propionate. Clin Pharmacokinet 2000; 39 {suppl): l-54. When applied topically, particularly to large areas, when 3. Daley-Yates PT, Baker RC. Systemic bioavailability of fluticasone propionate administered as nasal drops and aqueous nasal spray the skin is broken, or under occlusive dressings, formulations. Br J Clin Pharmacal 2001; 51: 103-5. corticosteroids may be absorbed in sufficient amounts to 4. Allen A, et al. Absolute bioavailability of intranasal fluticasone furoate in cause systemic effects. Inhalation or nasal use of large healthy subjects. Clin Ther 2007; 29: 1415-20. amounts of fluticasone may produce systemic effects also (see below). Prepar (]lic:>n.�............ ..................................... USP 36: (Halcinonide). A white to off-white, odourless� Proprietary Preparations (details are given in Volume B) crystalline powder. Insoluble in water and in hexanes; Adrenal suppressian. Despite the fact that inhaled flutica­ Single�ingredient Preparations. Arg.: Alenys; Balivent; Crivanil; slightly soluble in alcohol and in ether; soluble in acetone sone is generally thought to lack systemic effects at thera­ Cutivate; Flixonase; Flixotide; Fluti-K; Fluticort; Inhalan; Lidil and in chloroform. peutic doses, a study in 25 healthy subjects1 indicated that Cort; Lirtodac; Proair; Rinisona; Austral.: Avamys; Flixonase fluticasone propionate as single inhaled doses of 250, 500, Allergy & Hayfever 24 Hour; Flixonase; Flixotide; Austria: Ava­ and 1000 micrograms did produce a reduction in plasma mys; Cutivate; Flixonase; Flixotide; Belg.: Avamys; Cutivate; Profile cortisol, indicating suppression of the hypothalamic-pitui­ Flixonase; Flixotide; Braz.: Avamys; Flixonase; Flixotide; Fluti­ Halcinonide is a corticosteroid used topically for its tary-adrenal axis to some degree. Others have also found can; Fluticaps; Flutivate; Plurair; Canad.: Avamys; Cutivate; glucocorticoid activity (p. 1597.1) in the treatment of evidence of adrenal suppression with fluticasone,2·5 parti­ Flonase; Flovent; Chile: Albeoler; Alenys; Avamys; Brexonase; various skin disorders. It is usually used as a 0.1% cream, cularly at high doses and in children, 6 and the effect may Brexoventt; Flixonase; Flixotide; Flucomix; Flusona; Fluticon; lotion, or ointment. · Flutivate; Nebulex; Raffonin; China: Cutivate be more marked with repeated than with single doses.4•6 8 (5�.J!J!l(); When applied topically, particularly to large areas, when Flixonase Flixotide Cz. : Alergonaset; Ali­ Several cases of adrenal crisis have been associated with (�!ifil!); (11i!if�)iJ); the skin is broken, or under occlusive dressings, sade; Avamys; Cutivate; Flixonaset; Flixotide; Nasofan; Denm.: high-dose inhaled fluticasone/·10 including at least one corticosteroids may be absorbed in sufficient amounts to Avamys; Cutivat; Flixonase; Flixotide; Flutide; Fin.: Flixonase; fatality 6 It has been recommended that children using cause systemic effects (p. 1615.3). The effects of topical inhaled fluticasone at doses above 400 micrograms daily Flixotide; Flutide; Nasofan; Fr.: Avamys; Flixonase; Flixotide; Flixovate; Ger.: Atemurt; Avamys; Fluticat; Flutide; Flutivate; corticosteroids on the skin are described on p. 1617.3. For should have adrenal function monitoring and a written Gr.: Alerxem; Avamys; Bocacort-S; Cortixide; Dennocort; Plica­ recommendations concerning the correct use of corticoster­ plan for emergency corticosteroid replacement therapy 6 zen; Flihaler; Flixocort; Flixoderm; Flixonase; Flixotide; Flixo­ oids on the skin, and a rough guide to the clinical potencies 1. Grahn€n A, et al. An assessment of the systemic activity of single doses of tide; Flucortis; Flutarzole; Fluticapen; Flutikrem; Flutinasal; of topical corticosteroids, see p. 1599.2. inhaled fluticasone propionate in healthy volunteers. Br J C!in Pharmacal 1994; 38: 521-5. Flutizal; Nasofan; Salenga; Ybecor; Hong Kong: Avamys; Cuti­ 2. Clark DJ, et al. Comparative systemic bioaL1ivity of inhaled budesonide vate; Dalman; Dermcasone; Flixonase; Flixotide; Lutisone; Preparations and fluticasone propionate in asthmatic children. Br J Clin Pharmacal Nasofan; Hung.: Avamys; Cutivate; Flixonase; Flixotide; Flutir­ ....... ............. 1996; 42: 264P. in; India: Flixonase; Floease; Flohale; Flomist; Flucasia; Fluster; ProprietaryPreparations (details are given in Volume B) 3. Rohatagi S, et al. Dynamic modeling of cortisol reduction after inhaled Flute; Fluticare; Fluticone; Flutiflo; Flutivate; Flutopic; Moli­ administration of flutkasone propionate. J Clin Pharmaco/ 1996; 36: 938-- derm; Nezaflo; Otrivin-C; Zoflut; Indon.: Avamys; Cutivatet; Single-ingredient Preparations. Braz. : Halog; Canad.: Halogt; 41. Flixonase; Flixotide; Medicort; Irl. : Avarnys; Flixonase; Flixo­ 4. Clark DJ, Lipworth BJ. Adrenal suppression with chronic dosing of China: Ha Le Te (�!@"*�); Cz.: Betaconont; Gr.: Ascochrom; fluticasone propionate compared with budesonide in adult asthmatic tide; Nasofan; Israel: Allegro; Avamys; Flixonase; Flixotide; Flu­ Hamiltoderm-D; Hong Kong: Halogt; India: Cortilate; Indon.: patients. Thorax 1997; 52: 55-8. titrim; Ital.: Avamys; Flixoderrn; Flixonase; Flixotide; Fluspiral; Halogt; Ital. : Halciderm; Mex. : Dermalog; Switz. : Betacortone; 5. Eid N, et a!. Decreased rnoming serum cortisol levels in children with Fluticrem; Nasofan; Ticavent; Jp n: Flonaset; Malaysia: Ava­ Turk.: Volog; USA: Halog; Venez. : Halog. asthma treated with inhaled fluticasone propionate. Pediatn"cs 2002; 109: mys; Cutivate; Flixonase; Flixotide; Flomist; Mex. : Avamys; 217-2 1. Canetit; Cutivate; Flixonase; Flixotide; Neth.: Avamys; Cortifil; 6. Paton J, et al. Adrenal responses to low dose synthetic ACTH Multi-ingredient Preparations. Braz. : Halog Capilar; Cz. : Betacor­ Cutivate; Flixonase; Flixotide; Fluticrem; Flutide; Norw.: Ava­ (Synacthen) in children receiving high dose inhaled fluticasone. Arch Dis ton Sf; Betacorton Ut; India: Cobederm-Ht; Cortilate-N; Corti­ Child 2006; 91: 808-13. mys; Flutide; Flutivate; NZ: Flixonase; Flixotide; Nasacleart; late-S; Halog-E; Orkid-S; Ital. : Halciderm Combi; Halciderm; 7. LOnnebo A, et al. An assessment of the systemic effects of single and Philipp. : Avamys; Cutivate; Flixotide; Nasoflo; Pol. : Alisade; Mex. : Dermalog-C; Switz. : Betacortone S; Betacortone; Turk. : repeated doses of inhaled lluticasone propionate and inhaled budeso­ Avamys; Cutivate; Fanipos; Flixonase; Flixotide; Port.: Asmatil; Betacorton; Venez.: Halcicomb; Halog. nide in healthy volunteers. Eur J Clin Pharmacal 1996; 49: 459-63. Asmo-Lavi; Avamys; Brisovent; Cutivate; Eusticlil; Flixotaide; AM 8. Wilson , et a!. Adrenal suppression with high doses of inhaled Flutaide; Rontilona; Ubizol; Rus.: Avamys (ABaMHc); Cutivate f!uticasone propionate and triamcinolone acetonide in healthy Pharmacopoeial Preparations (KyTHBeih); Flixonase (cl>nHKCOH3.3e); Flixotide (cl>JIHKCOTH.U); voluteers. Bur J Clin Pharmacol 1997; 53: 33-7. USP 36: Halcinonide Cream; Halcinonide Ointment; Halcinonide 9. Todd GRG, et al. Survey of adrenal crisis associated with inhaled Nazare! (Ha3aperr); S.Afr. : Avamys; Cutivate; Flixonase;