Fluticasone Propionate: Brands, Price & Uses in Bangladesh

Fluticasone Propionate is a synthetic corticosteroid used topically (intranasally, by oral inhalation, or by nebulisation) for its local anti-inflammatory effect. In Bangladesh it is marketed as a nasal spray, a pressurized/dry powder inhaler, and a nebuliser suspension.

Established / FDA-approved and guideline-supported uses

• Allergic rhinitis (nasal spray): Prophylaxis and treatment of symptoms of seasonal and perennial allergic rhinitis (sneezing, nasal congestion, rhinorrhoea, itching) in adults and children.
• Nasal polyps (nasal spray, higher strength): Treatment of chronic rhinosinusitis with or without nasal polyps, and prevention of polyp recurrence after surgical removal.
• Asthma - maintenance/prophylaxis (inhaler and nebuliser suspension): Regular maintenance treatment of mild, moderate, and severe persistent asthma in adults and children, including patients previously controlled on bronchodilators alone or on other inhaled corticosteroids.

Uses requiring combination therapy

• In patients with more severe or poorly controlled asthma, Fluticasone Propionate is often combined with a long-acting beta-agonist (LABA, e.g. salmeterol or formoterol) as part of a step-up regimen, rather than used alone.

Important exclusion

Fluticasone Propionate inhaler/nebuliser suspension is not indicated for the relief of acute bronchospasm or as a rescue treatment for status asthmaticus or other acute asthma episodes; a fast-acting bronchodilator ("reliever" inhaler) is required for that purpose.

Allergic rhinitis / nasal polyps - Nasal spray

Administration: Shake the bottle gently before use, prime before first use, tilt head slightly forward, insert nozzle into one nostril pointing away from the nasal septum, and spray while gently breathing in through the nose; avoid spraying directly onto the septum.

Asthma maintenance - Inhaler (pMDI/DPI)

Asthma maintenance - Nebuliser suspension

Typically 0.5-2 mg twice daily via jet nebuliser, dose individualised by age and asthma severity, and stepped down to the lowest effective dose once control is achieved.

Administration: Shake the inhaler before use; use a spacer device where recommended, especially in children; hold the breath for about 10 seconds after inhalation; always rinse the mouth with water (and spit it out) after each inhaled dose to reduce the risk of oral thrush and hoarseness.

Dose should be titrated to the lowest amount that maintains effective control of symptoms; do not use for immediate relief of acute bronchospasm (see Indications and Precautions).

Local effects

• Nasal spray: Nasal dryness, irritation, unpleasant taste/smell, epistaxis (nosebleed), nasal ulceration; rarely, nasal septal perforation with prolonged use.
• Inhaler/nebuliser: Oral and throat candidiasis (thrush), hoarseness (dysphonia), throat irritation, and occasionally paradoxical bronchospasm immediately after dosing - rinse the mouth after each inhaled dose to reduce this risk.

Systemic effects (uncommon at recommended doses, more likely with high-dose or prolonged use)

• HPA-axis (adrenal) suppression, Cushingoid features
• Reduced growth velocity in children
• Reduced bone mineral density with long-term use
• Increased risk of cataracts and glaucoma with prolonged use
• Increased risk of pneumonia has been observed in patients with COPD using inhaled Fluticasone Propionate-containing products

Hypersensitivity reactions (rash, angioedema, bronchospasm, anaphylaxis) are rare but can occur.