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Fluticasone
Systematic (IUPAC) name
S-(fluoromethyl) (6S,8S,9R,10S,11S,13S,14S,16R,17R)- 6,9-difluoro-11,17-dihydroxy-10,13,16-trimethyl-3-oxo- 6,7,8,11,12,14,15,16-octahydrocyclopenta[a] phenanthrene-17-carbothioate
Identifiers
CAS number	80474-14-2
ATC code	D07AC17 & D07AC04 topical, R01AD08 nasal, R03BA05 inhaled
PubChem	5311101
DrugBank	APRD00065
Chemical data
Formula	C22H27F3O4S
Mol. mass	444.508 g/mol
Pharmacokinetic data
Bioavailability	0.51% (Intranasal)
Protein binding	91%
Metabolism	Intranasal Hepatic (CYP3A4-mediated)
Half life	10 hours
Excretion	Renal
Therapeutic considerations
Pregnancy cat.	C for Intranasal and Inhaled
Legal status	POM(UK)
Routes	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 and Flixonase by Allen & Hanburys, and Flovent, Flonase, and Veramyst by GlaxoSmithKline. GlaxoSmithKline also markets a combination of fluticasone and salmeterol as Advair (US) or Seretide (UK).

It is also used as a cream or ointment for the treatment of eczema and psoriasis (Cutivate UK).

Contents 1 Mechanism of action 2 Nasal spray 2.1 Dosage 2.2 Flonase patent issues 3 References 3.1 Clinical trials 4 External links

Inflammation is recognized as an important component in the pathogenesis of asthma. Glucocorticoids have been shown to inhibit multiple cell types (e.g., mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils) and mediate production or secretion (e.g., histamine, eicosanoids, leukotrienes, and cytokines) 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.

• Adults: The recommended dosage for adults is 100 micrograms (two sprays) into 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) to each nostril daily.

• 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.

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.[1] The ruling meant that sales of generic versions of Flonase could proceed.

• GSK's official statement on Flonase generic
• RxList The Internet Drug Index
• BNF 45 March 2003

This listing is NOT complete and should NOT be construed as support for treatment decisions. See also PubMed clinical manuscripts referring to fluticasone

• Burge P, Calverley P, Jones P, Spencer S, Anderson J, Maslen T (2000). "Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial.". BMJ 320 (7245): 1297-303. PMID 10807619. 
• Paggiaro P, Dahle R, Bakran I, Frith L, Hollingworth K, Efthimiou J (1998). "Multicentre randomised placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. International COPD Study Group.". Lancet 351 (9105): 773-80. PMID 9519948. 

both support a positive outcome for use of fluticasone in patients with chronic obstructive pulmonary disease, also referred to as COPD

• Flixonase Official Website

v • d • e Decongestants and other nasal preparations (R01)
Topical: sympathomimetics, plain	Cyclopentamine - Ephedrine - Phenylephrine - Oxymetazoline - Tetryzoline - Xylometazoline - Naphazoline - Tramazoline - Metizoline - Tuaminoheptane - Fenoxazoline - Tymazoline - Epinephrine
Topical: antiallergic agents, excluding corticosteroids	Cromoglicic acid - Levocabastine - Azelastine - Antazoline - Spaglumic acid - Thonzylamine - Nedocromil - Olopatadine
Topical: corticosteroids	Beclometasone - Prednisolone - Dexamethasone - Flunisolide - Budesonide - Betamethasone - Tixocortol - Fluticasone - Mometasone furoate - Triamcinolone
Topical: other nasal preparations	Calcium hexamine thiocyanate - Retinol - Ipratropium bromide - Ritiometan - Mupirocin - Hexamidine - Framycetin
Systemic use: Sympathomimetics	Phenylpropanolamine - Pseudoephedrine - Phenylephrine

v • d • e Drugs for obstructive airway diseases: asthma/COPD (R03)
Adrenergics, inhalants	Short acting β2-agonists: Salbutamol/Levosalbutamol • Fenoterol • Terbutaline Long acting β2-agonists (LABA): Bambuterol • Clenbuterol • Formoterol • Salmeterol other: Epinephrine • Isoproterenol • Orciprenaline
Glucocorticoids	Beclometasone • Budesonide • Ciclesonide • Fluticasone • Mometasone
Anticholinergics	Ipratropium • Tiotropium
Mast cell stabilizers	Cromoglicate • Nedocromil
Xanthines	Aminophylline • Theobromine • Theophylline
Leukotriene antagonists	Montelukast • Pranlukast • Zafirlukast
Combination products	Budesonide/formoterol • Fluticasone/salmeterol • Ipratropium/salbutamol

v • d • e Corticosteroids - glucocorticoid/receptor and mineralocorticoid/receptor (A07EA, C05AA, D07, D10AA, H02, R01AD, R03BA, S01BA, S02B, and S03B)
Endogenous	Aldosterone, Cortisone, Hydrocortisone/cortisol, Desoxycortone
Others	Alclometasone, Amcinonide, Beclometasone, Betamethasone, Budesonide, Ciclesonide, Clobetasol, Clobetasone, Clocortolone, Cloprednol, Cortivazol, Deflazacort, Deoxycorticosterone, Desonide, Desoximetasone, Dexamethasone, Diflorasone, Diflucortolone, Difluprednate, Fluclorolone, Fludrocortisone, Fludroxycortide, Flumetasone, Flunisolide, Fluocinolone acetonide, Fluocinonide, Fluocortin, Fluocortolone, Fluorometholone, Fluperolone, Fluprednidene, Fluticasone, Formocortal, Halcinonide, Halometasone, Hydrocortisone aceponate, Hydrocortisone buteprate, Hydrocortisone butyrate, Loteprednol, Medrysone, Meprednisone, Methylprednisolone,Methylprednisolone aceponate, Mometasone furoate, Paramethasone, Prednicarbate, Prednisone, Prednisolone, Prednylidene, Rimexolone, Tixocortol, Triamcinolone, Ulobetasol