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Fluticasone - Interactions and Warnings

Active cigarette smoking impairs the efficacy of short term inhaled corticosteroid treatment in mild asthma. This finding has important implications for the management of patients with mild asthma who smoke.
- Thorax 2002 Mar;57(3):226-30 -- Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. -- Chalmers GW, Macleod KJ, Little SA, Thomson LJ, McSharry CP, Thomson NC.

Steroid inhaler laryngitis, a clinical entity that is caused by the use of inhaled fluticasone propionate and manifested by dysphonia, throat clearing, and fullness.
- Arch Otolaryngol Head Neck Surg 2002 Jun;128(6):677-81 -- Steroid inhaler laryngitis: dysphonia caused by inhaled fluticasone therapy. -- DelGaudio JM.

This study indicates that discontinuation of fluticasone propionate in patients with chronic obstructive pulmonary disease is associated with a more rapid onset and higher recurrence-risk of exacerbations and a significant deterioration in aspects of Health-Related Quality of Life.
- Am J Respir Crit Care Med 2002 Nov 15;166(10):1358-63 -- Effect of discontinuation of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: the COPE study. -- van der Valk P, Monninkhof E, van der Palen J, Zielhuis G, van Herwaarden C.

Inhaled steroids are safe at normal doses, but beware very high doses, especially of fluticasone.
- Arch Dis Child 2002 Dec;87(6):455-6 -- Inhaled corticosteroids and adrenal insufficiency. -- Russell G.

Aspergillus is a ubiquitous mold that can cause several types of symptomatic infections: allergic aspergillosis, typically in young atopic patients; aspergillomas (often referred to as fungus balls); and invasive aspergillosis, typically seen in debilitated or immunocompromised patients. We describe an 85-year-old woman who was not immunocompromised but had invasive aspergillosis of the paranasal sinus that resulted in unilateral headache and retrobulbar optic neuropathy. After extensive differential diagnostic examination, we concluded that the condition was possibly related to the long-term use of nasal corticosteroids (fluticasone propionate aqueous nasal spray).
- Mayo Clin Proc 2002 Dec;77(12):1353-7 -- Aspergillosis related to long-term nasal corticosteroid use. -- Bratton RL, Brazis PW, Hellinger WC, Wharen RE Jr, Broderick DF.

Results suggest that topical anti-inflammatory drugs may diminish airway eosinophilic infiltration by decreasing eosinophil viability, that nasal polyp epithelial cell secretions may induce steroid resistance in eosinophils, and that nedocromil sodium has additive effects with steroids.
- Clin Exp Allergy 1997 Dec;27(12):1432-41 -- Effects of topical anti-inflammatory drugs on eosinophil survival primed by epithelial cells. Additive effect of glucocorticoids and nedocromil sodium. -- Mullol J, Lopez E, Roca-Ferrer J, Xaubet A, Pujols L, Fernandez-Morata JC, Fabra JM, Picado C.

The case history is presented of a patient with cystic fibrosis in whom the treatment of allergic bronchopulmonary aspergillosis with itraconazole produced an initial response but was complicated by profound adrenal shutdown and impairment of inhaled steroid clearance resulting in paradoxical Cushing's syndrome. The authors conclude that, while it is laudable to attempt to reduce the steroid burden in any patient, it is imperative that due vigilance is exercised when using a combination of agents which interact. If such a combination therapy is embarked upon, regular assessment of the pituitary adrenal axis is advisable.
- Thorax 2002 Aug;57(8):749-50 -- Profound adrenal suppression secondary to treatment with low dose inhaled steroids and itraconazole in allergic bronchopulmonary aspergillosis in cystic fibrosis. -- Parmar JS, Howell T, Kelly J, Bilton D.

In HIV-infected patients, ritonavir, a potent cytochrome P450 inhibitor, is increasingly used to improve the pharmacokinetic profile of the associated protease inhibitor. HIV physicians are often faced with potential drug-drug interaction while treating associated diseases. We report the case of an HIV-infected patient with clinical features of Cushing's syndrome due to the interaction of low dose ritonavir with inhaled fluticasone propionate (FP). Safety of life-long CYP450 inhibition has still to be demonstrated.
- J Infect 2002 Apr;44(3):194-5 -- Iatrogenic Cushing's syndrome in an HIV-infected patient treated with inhaled corticosteroids (fluticasone propionate) and low dose ritonavir enhanced PI containing regimen. -- Clevenbergh P, Corcostegui M, Gerard D, Hieronimus S, Mondain V, Chichmanian RM, Sadoul JL, Dellamonica P.

Not recommended if you are pregnant, planning to be or breastfeeding. Use extreme caution before using with other steroid containing medications. Consult with your physician before using herbs and supplements.

last update: November 2008

This information is not intended to be a substitute for professional medical advice. You should not use this material to diagnose or treat a health condition or disease without consulting with your healthcare provider.
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