Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.
metered dose inhalers delivering 50 and 250 micrograms per inhalation
disks of blisters delivering 100 and 500 micrograms per inhalation
Indication: asthma prophylaxis
Anti inflammatory drugs have an important role in asthma management (see `The changing approach to the pharmacotherapy of asthma' Aust Prescr 1991;14:71-3). Fluticasone adds to the choice of available inhaled steroids.
There has been recent concern about the effect of inhaled steroids on the growth of children. Fluticasone can affect the hypothalamicpituitary axis, particularly with prolonged treatment or at high doses. However, no stunting of growth has yet been observed. If some of the dose is swallowed rather than inhaled, it is unlikely to cause any systemic effect as the biovailability of oral fluticasone is low.
The product is available in a variety of strengths, either as a metered dose inhaler or as dry powder contained in blisters for use in the Flixotide Diskhaler. Fluticasone is inhaled twice a day with the dose being tailored to each patient's requirements. Caution is advised when changing from the dry powder to the aerosol form of fluticasone and patients transferring from beclomethasone therapy are recommended to begin fluticasone at half the total daily dose of beclomethasone.
While fluticasone may be more potent than beclomethasone at the same dose, both drugs are effective and it is unclear if better control, e.g. reduced frequency of exacerbations, is achieved with fluticasone.