Fluticasone dosage

Salmeterol is also available in a fixed ratio combination product containing fluticasone, and a new drug application has been filed for a fixed combination product containing budesonide and formoterol. Combination products have the potential advantage of increasing patient adherence due to the decreased number of inhalers and inhalations however, these products offer less flexibility with respect to dosage adjustments when necessary. 

Chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis For the twice-daily maintenance treatment of airflow obstruction in patients with COPD associated with chronic bronchitis. Fluticasone propionate/salmeterol 250 meg per 50 meg twice daily is the only approved dosage for the treatment of COPD associated with chronic bronchitis. Fligher doses, including fluticasone propionate/salmeterol 500 meg per 50 meg, are not recommended. 

Children 4 to 11 years of age - For patients 4 to 11 years of age who are symptomatic on an inhaled corticosteroid, the dosage is 1 inhalation of fluticasone propionate/salmeterol 100 meg per 50 meg twice/day (morning and evening, approximately 12 hours apart). 

Modification of the pharmacokinetics through structural alterations has provided several new steroids with a better GR affinity and therapeutic index and a lower bioavailability than the older drugs (Fig. 33.14). The new inhaled/intranasal glucocorticosteroids like mometasone furoate, budesonide and fluticasone propionate are more lipophilic than those used in oral and systemic therapy and have greater affinity for the GR than does dexamethasone as a consequence of their greater lipophilicity (43). Several of the topical corticosteroids, such as mometasone furoate, BDP, triamcinolone acetonide, and flunisolide, were reintroduced as inhalation and intranasal dosage forms for treatment of respiratory diseases (e.g., asthma or rhinitis). Inhaled budesonide and flunisolide are readily absorbed from the airway mucosa into the blood and are rapidly biotransformed in the liver into inactive metabolites. Mometasone furoate and fluticasone propionate are very potent anti-inflammatory steroids with an oral bioavailability of less than 1%. Obviously, the risk of systemic side effects for these newer corticosteroids is greatly reduced when compared with ... 

All currently used inhaled corticosteroids are rapidly cleared from the body but show varying levels of oral bioavailability, with fluticasone propionate having the lowest (Table 33.5). Following inhalation, there also is considerable variability in the rate of absorption from the lung, and pulmonary residence times are greatest for fluticasone propionate and triamcinolone acetonide and shortest for budesonide and flunisolide. Adrenal suppression has not been observed when intranasal fluticasone propionate was administered in dosages of 200 to 4,000 pg daily for up to 12 months. 

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