Fluticasone belongs to the class of medications called inhaled corticosteroids, which reduce symptoms of asthma and prevent asthma attacks by decreasing inflammation in the lungs and thereby opening the airways. When used regularly every day, inhaled fluticasone decreases the number and severity of asthma attacks. However, it will not relieve an asthma attack that has already started.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

The recommended regular daily dose of fluticasone inhalation is the lowest dose required to control asthma symptoms. The full benefit of this medication may take 1 to 2 weeks or longer to achieve.

The usual dose for adults and adolescents over 16 years of age is 100 µg to 500 µg twice daily (the number of inhalations varies depending on strength of medication used). For people with very severe asthma, higher doses up to 1,000 µg twice daily may be needed.

The usual dose for children between 4 and 16 years of age is 100 µg twice daily (the number of inhalations varies depending on strength of medication used). On occasion, a dose of 200 µg may be needed to control asthma symptoms. Your doctor may tell you to adjust the dose of this medication in order to find one that helps control your asthma symptoms.

Children 12 months to 4 years of age may be given 100 µg twice daily, using a spacer device. The dose should be given as a single 50 µg actuation of the HFA inhaler into the spacer device, inhaled, and then repeated. The Diskus form of this medication should not be used by children under the age of 4 years.

Inhaled fluticasone is used to prevent asthma attacks. It is not used to relieve an attack that has already started. For relief of an asthma attack that has already started, you should use another medication. If you do not have another medication to use for an attack or if you have any questions about this, check with your health care professional. If your doctor has asked you to use a "reliever" inhaler such as salbutamol or terbutaline with your fluticasone inhaler, you should use the reliever inhaler first, wait several minutes, and then use the fluticasone inhaler. The reliever medication will provide immediate relief of symptoms of asthma attack, while the fluticasone inhalation works to treat and control asthma regularly.

Before using the inhaler for the first time, or after 7 days without using it, the device must be primed. Shake the device well for 5 seconds, then remove the cover and, pointing the mouthpiece away from yourself, depress the cannister. Repeat these steps a second time, starting with shaking the device.

Shake the HFA inhaler well before use or before inserting the mouthpiece into the spacer device. In order to get the most medication into the lungs from the inhaled dose, ask your doctor or pharmacist about proper techniques for taking this medication.

Rinsing your mouth and gargling with water after each inhalation can help prevent hoarseness, throat irritation, and infection in the mouth caused by candidiasis (a type of yeast infection of the mouth; also known as "thrush"). If you have dentures, they should be cleaned after each dose.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not administer a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store the Diskus blisters in the sealed foil wrap that it is packaged in, until you are ready to put the disk in the device for use. Store this medication at room temperature, out of direct sunlight and out of reach of children. Protect the inhaler and Diskus blisters from freezing. Do not store the Diskus in a damp environment.

Each actuation of the pressurized metered-dose inhaler delivers: 50 µg, 125 µg, or 250 µg of fluticasone propionate suspended in propellant HFA-134a (1,1,1,2-tetrafluoroethane). This product does not contain chlorofluorocarbons (CFCs) as the propellant.

Apo-Fluticasone HFA inhalation aerosol is a pressurized metered-dose inhaler (MDI) consisting of an aluminium canister fitted with a metering valve. The 125 µg canister is fitted into the supplied orange actuator/adaptor. The 250 µg canister is fitted into the supplied red/brown actuator/adaptor.

Do not use fluticasone if you:

• are allergic to fluticasone or any ingredients of the medication
• have active or inactive untreated pulmonary tuberculosis
• have untreated fungal, bacterial, or viral infections
• need treatment for status asthmaticus or other acute asthma conditions

Do not give this medication to children less than 12 months of age.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• cough
• difficulty sleeping
• fever
• headache
• hoarseness, voice change
• nasal congestion
• runny nose
• sore mouth and tongue
• sore throat

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• anxiety
• behaviour changes (e.g., hyperactivity, irritability)
• fever
• inability to speak
• increased skin bruising
• more frequent infections
• osteoporosis or bone fractures, or ongoing bone pain
• pins and needles or numbness of arms or legs, sinus pain and congestion, worsening breathing problems (Churg-Strauss Syndrome)
• signs of respiratory tract infection (e.g., fever or chills, shortness of breath, prolonged dizziness, headache, weight loss, tightness in chest, difficulty breathing, or wheezing)
• signs of too much corticosteroid (e.g., round face, rapid weight gain, increased sweating, thinning of skin, muscle weakness)
• signs of thrush (e.g., white patches in mouth and throat, sore throat)
• slowed growth (children and adolescents)
• symptoms of decreased adrenal function (e.g., tiredness, weakness, nausea, vomiting, low blood pressure)
• symptoms of glaucoma or cataracts (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
• symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• skin rash or hives
• sudden shortness of breath and wheezing after using this medication
• worsening asthma symptoms

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Asthma attacks: This medication is not a "reliever" medication. If you start developing asthma symptoms, be sure to use your reliever medication (such as salbutamol or terbutaline) for rapid relief of your asthma symptoms. It is very important that you have your reliever medication with you at all times. If you persistently use more of your reliever medication, contact your doctor.

Bone effects: Long-term use of corticosteroids such as fluticasone may affect bone density and increase the risk of fracture. Your doctor will monitor your bone health while you are taking this medication.

Diabetes: Fluticasone may cause an increase in blood sugar levels. If you have diabetes, you may find it necessary to monitor your blood sugar more frequently while using this medication.

Eye problems: If you have glaucoma or cataracts or are at risk of developing them, have your eyes checked by your doctor before starting long-term treatment with this medication. Have your eyes monitored at regular intervals while using this medication.

Growth effects: Long-term use of corticosteroids, including inhaled forms such as this medication, may slow the growth of children and adolescents. It is important to use the lowest effective dose for managing asthma symptoms. Talk to your doctor if you have any concerns.

Infection: This medication, like other corticosteroids, may prevent the early signs of a serious infection from being noticed. Try to limit the amount of time you spend around others who have recently had infections such as chickenpox or measles. If you do come into contact with someone who has one of these infections, contact your doctor for advice.

Lactose: Certain formulations of fluticasone contain lactose. If you are allergic to lactose or milk proteins, check with your doctor or pharmacist to make sure the product you are using does not contain lactose.

Oral hygiene: Adequate oral hygiene is very important in minimizing the overgrowth of microorganisms such as candidiasis (thrush). Proper oral hygiene includes rinsing your mouth with water after using the inhaler. Thrush infections, should they occur, may require treatment with appropriate antifungal therapy or the discontinuance of treatment with fluticasone, depending on the severity of the infections.

Stopping this medication: Do not stop this medication suddenly, as this may result in withdrawal symptoms associated with suppressed adrenal glands (e.g., stomach discomfort or pain, worsening of asthma). Your doctor will tell you how to gradually lower the dose over a period of time in order to stop this medication properly.

Thyroid problems: People with decreased thyroid function (hypothyroid) may experience an increased effect from corticosteroids. If you have a history of thyroid problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Wheezing: This medication may cause the airways to spasm immediately after using the inhaler. If this happens, use your rescue inhaler as soon as possible to relieve the symptoms, then call your doctor as soon as possible.

Worsening of asthma: Increasing use of your bronchodilators (e.g., salbutamol) to control asthma symptoms is an indication that your asthma may be worsening. Sudden and progressive worsening in asthma control is potentially life-threatening, and consideration should be given to increasing the dose of fluticasone inhalation. Talk to your doctor or pharmacist to learn more about how to properly monitor for symptoms of worsening asthma.

Pregnancy: The safety of fluticasone for use during pregnancy has not been established. Potential benefits need to be weighed against risks, especially in the first trimester of pregnancy.

Breast-feeding: Corticosteroid medications such as fluticasone pass into breast milk. Although the amount that appears in breast milk would likely be low, the benefits of using this medication while breast-feeding need to be weighed against risk. If you are breast-feeding and are using fluticasone it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of this medication have not been established for children under the age of 4 years for the Diskus formulation and for children under the age of 12 years for the Respiclick formulations. Children and adolescents over the age of 12 months may safely use the HFA inhaler formulations.

There may be an interaction between fluticasone and any of the following:

• acetylsalicylic acid (ASA)
• aldesleukin
• aprepitant
• "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• calcium channel blockers (e.g., diltiazem, verapamil)
• cobicistat
• desmopressin
• dronedarone
• grapefruit juice
• HIV protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir)
• lenacapavir
• letermovir
• loxapine
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• mifepristone
• nirmatrelvir and ritonavir
• protein kinase inhibitors (e.g., ceritinib, crizotinib, idelalisib, imatinib)
• tobacco (smoked)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.