Inhaled Corticosteroid
Pregnancy: Compatible with pregnancy; ICS essential to maintain asthma control
Fluticasone Propionate
Brand names: Flixotide, Flixonase (nasal)
Adult dose
Dose: 100-500 micrograms twice daily (inhaled)
Route: Inhaled MDI / DPI
Frequency: Twice daily
Max: 1000 micrograms twice daily (severe asthma under specialist care)
Approximately twice as potent as beclometasone on a microgram-for-microgram basis
Paediatric dose
Dose: Fixed dose by age micrograms twice daily/kg
Route: Inhaled MDI with spacer
Frequency: Twice daily
Max: 200 micrograms twice daily (under 16 years without specialist input)
Child 1-4 years: 50-100 micrograms twice daily (only Flixotide 50 micrograms MDI licensed). Child 5-11 years: 50-100 micrograms twice daily. Child 12-17 years: 100-500 micrograms twice daily. Use spacer for all children; face mask for under 4 years. Not licensed under 1 year
Dose adjustments
Renal
No adjustment required
Hepatic
Increased systemic exposure possible in severe hepatic impairment; monitor
Paediatric weight-based calculator
Child 1-4 years: 50-100 micrograms twice daily (only Flixotide 50 micrograms MDI licensed). Child 5-11 years: 50-100 micrograms twice daily. Child 12-17 years: 100-500 micrograms twice daily. Use spacer for all children; face mask for under 4 years. Not licensed under 1 year
Clinical pearls
- MHRA 2018 safety alert: Ritonavir and cobicistat co-administration with fluticasone can cause iatrogenic Cushing syndrome and adrenal suppression — avoid unless benefit outweighs risk; switch ICS if antiretroviral therapy needed
- More potent than beclometasone CFC — when switching, check equivalent doses to avoid under- or over-treatment
- Always rinse mouth after use to prevent oropharyngeal candidiasis
- Growth suppression: use minimum effective dose; monitor height with stadiometer at each annual review
- Step down therapy when asthma well-controlled for 3 months per BTS/SIGN guideline
Contraindications
- Hypersensitivity to fluticasone
- Active pulmonary tuberculosis (untreated)
Side effects
- Oropharyngeal candidiasis
- Dysphonia
- Adrenal suppression at high doses
- Growth suppression (children)
- Paradoxical bronchospasm (rare)
Interactions
- Ritonavir and cobicistat (CYP3A4 inhibitors — markedly increase plasma fluticasone; avoid combination; risk of Cushing syndrome and adrenal suppression)
- Itraconazole / ketoconazole (similar interaction)
Monitoring
- Lung function (PEF/FEV1)
- Height annually (growth)
- Signs of adrenal suppression with high doses or prolonged use
Reference: BNF for Children; BTS/SIGN Asthma Guidelines 2019; MHRA Drug Safety Update 2018 (fluticasone/ritonavir); NICE NG80. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators