Adult: As fluticasone propionate metered-dose inhaler (50 mcg/actuation, 125 mcg/actuation, or 250 mcg/actuation) or dry powder inhaler (50 mcg/actuation, 100 mcg/actuation, 250 mcg/actuation, or 500 mcg/actuation): Mild asthma: Initially, 100 mcg bid. Moderate and severe asthma: Initially, 250-500 mcg bid. May increase dose up to 1,000 mcg bid if needed. As fluticasone propionate metered-dose inhaler (44 mcg/actuation, 110 mcg/actuation, or 220 mcg/actuation): Initially, 88 mcg bid; may increase dose after 2 weeks if response is inadequate. Max: 880 mcg bid. As fluticasone propionate nebule: For severe chronic asthma: 500-2,000 mcg bid. As fluticasone furoate dry powder inhaler (50 mcg/actuation, 100 mcg/actuation, or 200 mcg/actuation): Initially, 100 mcg once daily. Max: 200 mcg once daily. Doses must be individualised based on asthma severity; use the lowest effective maintenance dose. Dosage and treatment recommendations and expression of dosage units may vary among countries and between individual products (refer to specific product guidelines). Child: As fluticasone propionate metered-dose inhaler (50 mcg/actuation, 125 mcg/actuation, or 250 mcg/actuation) or dry powder inhaler (50 mcg/actuation, 100 mcg/actuation, 250 mcg/actuation, or 500 mcg/actuation): 4-15 years Initially, 50-100 mcg bid, may increase up to 200 mcg bid if control is inadequate; ≥16 years Same as adult dose. Alternative dosage recommendation for dry powder inhaler (50 mcg/actuation, 100 mcg/actuation, or 250 mcg/actuation): 4-11 years Initially, 50 mcg bid, may increase to 100 mcg bid after 2 weeks if response is inadequate; ≥12 years Initially, 100 mcg bid, may increase dose after 2 weeks if response is inadequate (Max: 1,000 mcg bid). As fluticasone propionate metered-dose inhaler (44 mcg/actuation, 110 mcg/actuation, or 220 mcg/actuation): 4-11 years 88 mcg bid; ≥12 years Same as adult dose. As fluticasone propionate nebule: 4-15 years 1,000 mcg bid; ≥16 years Same as adult dose. As fluticasone furoate dry powder inhaler (50 mcg/actuation, 100 mcg/actuation, or 200 mcg/actuation): 5-11 years 50 mcg once daily; ≥12 years Same as adult dose. Doses must be individualised based on asthma severity; use the lowest effective maintenance dose. Dosage recommendations, expression of dosage units, and approved starting age of use may vary among countries and between individual products (refer to specific product guidelines).
Adult: As fluticasone propionate spray (50 mcg/spray): Initially, 2 sprays (100 mcg) into each nostril once daily. Once adequate control is achieved, reduce to 1 spray (50 mcg) into each nostril once daily. As fluticasone furoate spray (27.5 mcg/spray): Initially, 2 sprays (55 mcg) into each nostril once daily. Once adequate control is achieved, reduce to 1 spray (27.5 mcg) into each nostril once daily. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Child: As fluticasone propionate spray (50 mcg/spray): 4-11 years 1 spray (50 mcg) into each nostril once daily; ≥12 years Same as adult dose. As fluticasone furoate spray (27.5 mcg/spray): 2-11 years Initially, 1 spray (27.5 mcg) into each nostril once daily; may be increased to 2 sprays (55 mcg) into each nostril once daily if needed to control symptoms. Once adequate control is achieved, reduce to 1 spray (27.5 mcg) into each nostril once daily. ≥12 years Same as adult dose. Dosage recommendations and approved starting age of use may vary among countries and between individual products (refer to specific product guidelines).
Nasal Nasal polyps
Adult: As fluticasone propionate drops: Instil 200 mcg (approx 6 drops) into each nostril once daily or bid for at least 4-6 weeks. Child: ≥16 years As fluticasone propionate drops: Same as adult dose.
Adult: As fluticasone propionate 0.05% cream or 0.005% ointment: Apply a thin film onto the affected areas once daily or bid. Re-evaluate diagnosis if condition does not improve within 2 weeks. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Child: ≥3 months As fluticasone propionate 0.05% cream or 0.005% ointment: Same as adult dose. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Topical/Cutaneous Atopic dermatitis
Adult: As fluticasone propionate 0.05% cream: Apply a thin film onto the affected areas once daily or bid. As fluticasone propionate 0.05% lotion: Apply a thin film onto the affected areas once daily. Re-evaluate diagnosis if condition does not improve within 2 weeks. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Child: ≥3 months As fluticasone propionate 0.05% cream or lotion: Same as adult dose. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
What are the brands available for Fluticasone in Singapore?
Inhalation: Nebule: May be diluted with sterile NaCl 0.9% solution if necessary.
Contraindications
Oral inhalation: Primary treatment of status asthmaticus or other acute asthma episodes requiring intensive measures. Topical: Acne, rosacea, perioral dermatitis, perianal and genital pruritus, pruritus without inflammation, dermatoses in infants less than 3 months (including dermatitis and nappy rash); untreated bacterial, fungal, or viral skin lesions. Contraindications may vary among countries and between individual products (refer to specific product guidelines).
Special Precautions
Patient with cataracts and/or glaucoma, active or quiescent pulmonary tuberculosis; systemic fungal, bacterial, viral, or parasitic infections, ocular herpes simplex, diabetes mellitus; psoriasis (topical); COPD, major risk factors for decreased bone mineral count such as prolonged immobilisation, family history of osteoporosis, postmenopausal status, advanced age, poor nutrition, tobacco use, or chronic use of drugs that can reduce bone mass (oral inhalation). Carefully monitor patients switching from systemic corticosteroid therapy to oral inhalation or nasal corticosteroid therapy due to potential adrenal insufficiency or withdrawal symptoms (including increased allergic symptoms). Avoid exposure to chickenpox or measles. Nasal fluticasone must be avoided in patients with recent nasal septal ulcers, nasal surgery, or nasal trauma until healing has occurred. Hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Systemic effects such as hypercortisolism or HPA axis suppression (particularly in children or at high doses for prolonged periods), manifestations of Cushing's syndrome, hyperglycaemia and glucosuria; increased IOP, cataracts, glaucoma; growth retardation (in children); hypersensitivity reactions (e.g. anaphylaxis, angioedema, rash, hypotension, urticaria); immunosuppression and may increase risk of infection (prolonged use); withdrawal symptoms (e.g. joint pain, muscle pain, lassitude, depression). Nasal: Local nasal effects (e.g. nasal septal perforation, nasal ulceration, nasal erosion, epistaxis, localised Candida albicans infections of the nose and/or pharynx). Topical: Local skin reactions (e.g. allergic contact dermatitis, acneiform eruptions, folliculitis, hypertrichosis, hypopigmentation, irritation, miliaria, perioral dermatitis, secondary infection, skin atrophy, striae); topical steroid withdrawal reactions (particularly after discontinuation of ≥6 months long-term use), may be manifested as severe redness which can spread beyond the initial affected area, itching, burning or stinging sensation, and skin peeling. Oral inhalation: Oral candidiasis; decreased BMD (long-term use); increased risk of pneumonia (particularly in patients with COPD). Rarely, vasculitis (eosinophilic granulomatosis with polyangiitis [formerly known as Churg-Strauss]) or other systemic eosinophilic conditions. Nervous system disorders: Headache. Respiratory, thoracic and mediastinal disorders: Throat irritation, hoarseness; dyspnoea, nasal dryness or discomfort (nasal); nasopharyngitis (oral inhalation). Skin and subcutaneous tissue disorders: Pruritus (topical); contusions (oral inhalation). Potentially Fatal: Oral inhalation: Paradoxical bronchospasm.
Oral inhalation: Rinse your mouth with water without swallowing after each inhaler use. Topical (long-term use of ≥6 months): Inform the doctor immediately if severe redness which can spread beyond the initial affected area, itching, burning or stinging sensation, and skin peeling occur after treatment discontinuation.
Monitoring Parameters
Monitor growth in adolescents and children via stadiometry. Monitor BMD, FEV1, peak flow, and other pulmonary function tests (oral inhalation). Assess for signs and symptoms of HPA axis suppression, glaucoma or cataracts, oral candidiasis (oral inhalation), eosinophilic conditions, and skin infections (topical). Consider performing routine eye exam (chronic use).
Overdosage
Oral inhalation: Symptoms: Suppression of adrenal function; acute adrenal crisis (very rarely in children over prolonged periods), manifested as hypoglycaemia and sequelae of reduced consciousness and convulsions.
Management: Supportive and symptomatic treatment. Gradually reduce the dose and manage patient closely.
Drug Interactions
Increased exposure and systemic corticosteroid adverse reactions with strong CYP3A4 inhibitors (e.g. ritonavir, cobicistat-containing drugs, clarithromycin, itraconazole, nefazodone, nelfinavir).
Action
Description: Mechanism of Action: Fluticasone is a potent corticosteroid with primarily glucocorticoid activity that exhibits anti-inflammatory, antipruritic, and vasoconstrictive properties. It suppresses the formation, release, and activity of endogenous inflammatory mediators (such as kinins, histamine, liposomal enzymes, and prostaglandins) by inducing phospholipase A2 inhibitory proteins (lipocortins), leading to inhibition of arachidonic acid release. In the treatment of asthma, fluticasone acts locally in the lung by blocking the late phase allergic response to allergens. Pharmacokinetics: Absorption: Systemically absorbed mainly via lungs (oral inhalation). Bioavailability: 13.9% (oral inhalation); <2% (nasal). Time to peak plasma concentration: 0.5-1 hour (oral inhalation). Distribution: Volume of distribution: 4.2 L/kg. Plasma protein binding: >99%. Metabolism: Metabolised in the liver by CYP3A4 to form 17β-carboxylic acid (inactive metabolite). Undergoes extensive first-pass metabolism. Excretion: Via faeces (as unchanged drug and metabolites); urine (<5% as metabolites). Elimination half-life: Oral inhalation: Approx 11.2 hours (fluticasone propionate); 24 hours (fluticasone furoate).
Chemical Structure
Fluticasone Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5311101, Fluticasone. https://pubchem.ncbi.nlm.nih.gov/compound/Fluticasone. Accessed Nov. 27, 2025.
Storage
Nasal: Nasal drops or spray: Store below 30°C. Do not freeze.
Topical: Cream/Ointment: Store below 30°C. Lotion: Store between 15-30°C. Do not refrigerate.
Inhalation: Dry powder or metered-dose inhaler: Store below 30°C. Nebules: Store upright below 30°C. Protect from light.
Storage recommendations may vary among countries and between individual products. Refer to specific product guidelines.
R03BA05 - fluticasone ; Belongs to the class of other inhalants used in the treatment of obstructive airway diseases, glucocorticoids. R01AD08 - fluticasone ; Belongs to the class of topical corticosteroids used for prophylaxis and treatment of allergic rhinitis. R01AD12 - fluticasone furoate ; Belongs to the class of topical corticosteroids used for prophylaxis and treatment of allergic rhinitis. R03BA09 - fluticasone furoate ; Belongs to the class of other inhalants used in the treatment of obstructive airway diseases, glucocorticoids. D07AC17 - fluticasone ; Belongs to the class of potent (group III) corticosteroids. Used in the treatment of dermatological diseases.
References
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