Fluticasone 729690 223047847 2008-07-02T10:00:57Z DOI bot 6652755 Citation maintenance. Formatted: title. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. {{drugbox | IUPAC_name = ''S''-(fluoromethyl)&nbsp;(6''S'',8''S'',9''R'',10''S'',11''S'',13''S'',14''S'',16''R'',17''R'')-<br>6,9-difluoro-11,17-dihydroxy-10,13,16-trimethyl-3-oxo-<br>6,7,8,11,12,14,15,16-octahydrocyclopenta[''a'']<br>phenanthrene-17-carbothioate | image = Fluticasone.svg | CAS_number = 80474-14-2 | ATC_prefix = D07 | ATC_suffix = AC17 | ATC_supplemental = & {{ATC|D07|AC04}} (topical) *{{ATC|R01|AD08}} (nasal) *{{ATC|R03|BA05}} (inhaled) *{{ATC|R01|AD12}} (furoate) | PubChem = 5311101 | DrugBank = APRD00065 | C=22 | H=27 | F=3 | O=4 | S=1 | molecular_weight = 444.508 g/mol | smiles = FCSC(=O)[C@@]1(OC(=O)CC)[C@H](C)C[C@H]2[C@@H]3C[C@H](F)C4=CC(=O)C=C[C@]4(C) [C@@]3(F)[C@@H](O)C[C@]12C | bioavailability = 0.51% (Intranasal) | protein_bound = 91% | metabolism = Intranasal<br>[[Liver|Hepatic]] ([[CYP3A4]]-mediated) | elimination_half-life = 10 hours | excretion = [[Kidney|Renal]] | pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X --> | pregnancy_US = <!-- A / B / C / D / X --> | pregnancy_category = C for Intranasal and Inhaled | legal_AU = <!-- Unscheduled / S2 / S3 / S4 / S8 --> | legal_CA = <!-- / Schedule I, II, III, IV, V, VI, VII, VIII --> | legal_UK = POM | legal_US = Rx-only | legal_status = | routes_of_administration = Intranasal, Inhaled, Topical Cream or Ointment }} '''Fluticasone''' is a potent synthetic [[corticosteroid]] often prescribed as treatment for [[asthma]] and [[allergic rhinitis]]. The related fluticasone propionate is marketed with the brand names '''Flixotide''' (UK) for asthma and '''Flixonase''' (UK) for allergic rhinitis by [[Allen & Hanburys]]. In the US, it is marketed for asthma as '''Flovent''', and allergic rhinitis as '''Flonase''', by [[GlaxoSmithKline]]. GlaxoSmithKline also markets a combination of [[fluticasone/salmeterol|fluticasone and salmeterol]] as '''Advair''' (US) or '''Seretide''' (UK). The related fluticasone furoate is marketed by GlaxoSmithKline as '''Veramyst''' (US) for the treatment of allergic rhinitis. It is also used as a cream or ointment for the treatment of [[eczema]] and [[psoriasis]] ('''Cutivate''' US & UK). == Mechanism of action == [[Inflammation]] is recognized as an important component in the pathogenesis of asthma. [[Glucocorticoid]]s have been shown to inhibit multiple cell types (e.g., [[mast cell]]s, [[eosinophil]]s, [[Basophil granulocyte|basophils]], [[lymphocyte]]s, [[macrophage]]s, and [[neutrophil]]s) and mediate production or secretion (e.g., [[histamine]], [[eicosanoid]]s, [[leukotriene]]s, and [[cytokine]]s) involved in the asthmatic response. These anti-inflammatory actions of glucocorticoids may contribute to their efficacy in asthma. Typically, however, the action on the cells affected requires several days. Therefore, inhaled steroids are not used for immediate relief of asthma, but instead as preventive and maintenance therapy. ==Nasal spray== ===Dosage=== *'''Adults:''' The recommended dosage for adults is 100 micrograms (two sprays in each nostril) once daily. This may be increased to maximum of twice daily use if required. When control is achieved dose is reduced to 50 micrograms (one spray) daily. [[Image:Flovent.jpg|thumb|left|A canister of Flovent in the inhaler.]] *'''Adolescents and children:''' The recommended dosage for children (4 years of age or older in US, but only from 12 years in UK) is 50 micrograms (one spray) into each nostril once daily. This may be increased to maximum of twice daily use if required. ===Flonase patent issues=== GlaxoSmithKline's patent on Flonase expired in May 2004. The Food and Drug Administration (FDA) approved the sale of a generic version of Flonase on [[February 22]], [[2006]]. On [[February 23]], [[2006]], GlaxoSmithKline (GSK) was able to obtain a temporary 10-day restraining order from a federal judge in [[Baltimore]] blocking the shipment and sales of the approved generic versions of Flonase. The restraining order lasted until [[March 6]], [[2006]]. The basis of the complaint by GSK was that the FDA failed to follow its own regulations in approving the generics and failed to apply the same quality standards for the generic version as it did for Flonase. GSK made these arguments in petitions filed with the FDA, but the FDA rejected those petitions. The Maryland District Court denied the request by GSK to extend the ban on Flonase generics beyond [[March 6]], [[2006]], and GSK released a statement that they would not appeal the ruling.[http://www.medicalnewstoday.com/medicalnews.php?newsid=39333] The ruling meant that sales of generic versions of Flonase could proceed. ==References== * [http://www.gsk.com/ControllerServlet?appId=4&pageId=402&newsid=754 GSK's official statement on Flonase generic] * [http://www.rxlist.com/cgi/generic/flutic_ids.htm RxList The Internet Drug Index] * [[British National Formulary|BNF]] '''45''' March 2003 ===Clinical trials=== ''This listing is NOT complete and should NOT be construed as support for treatment decisions.'' See also [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?termClinical=fluticasone&precision=specificity&strategy=therapy&filters=&orig_db=PubMed&db=PubMed&cmd=Search&term=%28fluticasone%29+AND+%28randomized+controlled+trial%5BPublication+Type%5D+OR+%28randomized%5BTitle%2FAbstract%5D+AND+controlled%5BTitle%2FAbstract%5D+AND+trial%5BTitle%2FAbstract%5D%29%29 PubMed clinical manuscripts referring to fluticasone] * {{cite journal | author = Burge P, Calverley P, Jones P, Spencer S, Anderson J, Maslen T | title = Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial | journal = BMJ | volume = 320 | issue = 7245 | pages = 1297–303 | year = 2000 | pmid = 10807619 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=10807619 | doi = 10.1136/bmj.320.7245.1297}} * {{cite journal | author = Paggiaro P, Dahle R, Bakran I, Frith L, Hollingworth K, Efthimiou J | title = Multicentre randomised placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. International COPD Study Group | journal = Lancet | volume = 351 | issue = 9105 | pages = 773–80 | year = 1998 | pmid = 9519948 | doi = 10.1016/S0140-6736(97)03471-5}} ::''both support a positive outcome for use of fluticasone in patients with [[chronic obstructive pulmonary disease]], also referred to as [[COPD]]'' ==External links== * [http://www.flixonase.co.uk Flixonase Official Website] * [http://www.flonase.com Flonase Official Website] * [http://www.veramyst.com Veramyst Official Website] * [http://www.gw-flovent.com Flovent Official Website] * [http://www.advair.com Advair Official Website] {{Nasal preparations}} {{Asthma_and_copd_rx}} {{Corticosteroids}} [[Category:Glucocorticoids]] [[Category:Pulmonology]] [[Category:Asthma]] [[es:Fluticasona]] [[fr:Fluticasone]] [[hu:Flutikazon]] [[ja:フルチカゾン]] [[pl:Flutikazon]] [[ru:Флутиказон]]