Flonase eent

Generic Name: Fluticasone Propionate eent
Class: Corticosteroids
VA Class: NT200
Molecular Formula: C₂₅H₃₁F₃O₅S
CAS Number: 80474-14-2

Introduction

Synthetic trifluorinated corticosteroid.^{1 2 3 6 7 8 26 48 65 66}

Uses for Flonase

Seasonal and Perennial Rhinitis

Symptomatic treatment of seasonal or perennial rhinitis when conventional therapy with antihistamines or decongestants is ineffective or is not tolerated.^{1 2 7 16 19 27 33 34 46 51 54 55 57 71 73 74 76 78 110 113 122 123}

Generally provides symptomatic relief of watery rhinorrhea, nasal congestion, sneezing, postnasal drip, and nasal itching;^{1 2 7 16 19 27 33 34 46 51 55 59 122 123 124} generally does not relieve signs and symptoms of conjunctivitis, although improvement in ophthalmic manifestations may occur.^{19 62 110 113}

Relieves symptoms in both allergic^{1 2 7 16 19 27 33 34 46 51 54 55 71 73 74 76 78 110 113 122 123} and nonallergic^{1 57 113} rhinitis, although experience is more extensive with allergic rhinitis.^{1 2 7 16 19 27 33 34 46 51 54 55 57 71 73 74 76 78 110 113 122 123}

Has been used successfully prior to the onset of the pollen season for the prophylaxis of symptoms of seasonal allergic rhinitis†.²¹

Flonase Dosage and Administration

Administration

Intranasal Administration

Administer by nasal inhalation using a metered-dose nasal spray pump.^{1 6}

Avoid contact with the eyes.¹

If used once daily, administer preferably in the morning.^{18 46 110 113} Generally, initiate therapy with once-daily dosing; some patients may obtain greater relief with twice-daily divided dosing.¹

Although regular dosing generally provides optimal benefit, as needed (prn) dosing may be adequate in some patients with seasonal allergic rhinitis.¹

Clear nasal passages prior to administration.^{6 b} If nasal passages are blocked, a topical nasal decongestant can be administered 5–15 minutes before intranasal administration.^{2 67 75 79 113}

Prime pump prior to initial use or after a period of nonuse (i.e., ≥1 week).^{1 6 b}

Tilt the head slightly forward, insert the nasal adapter into one nostril,^{6 b} and point the tip of the adapter toward the inflamed nasal turbinates and away from the nasal septum.^{67 79}

Pump the drug into one nostril^{6 b} while holding the other nostril closed and concurrently inspire through the nose.^{6 b} Repeat procedure for the other nostril.^{6 b}

After removing the nasal adapter and dust cap, these pieces should be rinsed in warm water and dried thoroughly;⁶ do not clean by inserting a sharp object into the piece.⁶

Dosage

Nasal inhaler delivers about 50 mcg of fluticasone propionate per metered spray and about 120 metered sprays per 16-g container.¹

Adjust dosage according to individual requirements and response.^{1 110}

Therapeutic effects of intranasal corticosteroids, unlike those of decongestants, are not immediate.^{1 6 13 16 27 46 48 51 52 115} This should be explained to the patient in advance to ensure compliance and continuation of the prescribed treatment regimen.¹

Generally assess response to the initial dosage 4–7 days after starting therapy; a reduction in maintenance dosage may be possible at that time.¹

Pediatric Patients

Seasonal Rhinitis

Intranasal Inhalation

Adolescents and children ≥4 years of age: 1 spray (50 mcg) in each nostril once daily (total dose: 100 mcg/day).¹ Increase dosage to 2 sprays (100 mcg) in each nostril daily (total dose: 200 mcg/day) if response is inadequate.¹

Reduce dosage to 1 spray in each nostril (total dose: 100 mcg/day) once adequate symptom control is achieved.

Some patients ≥12 years of age with seasonal allergic rhinitis may find as needed (prn) use of 200 mcg (100 mcg in each nostril) doses (no more frequently than once daily) to be effective in controlling symptoms.¹ Greater symptom control may be achieved with regular dosing.¹

Perennial Rhinitis

Intranasal Inhalation

Adolescents and children ≥4 years of age: 1 spray (50 mcg) in each nostril daily (total dose: 100 mcg/day).¹ Increase dosage to 2 sprays (100 mcg) in each nostril daily (total dose: 200 mcg/day) if response is inadequate.¹

Maintenance dose is 1 spray in each nostril (total dose: 100 mcg/day) once adequate symptom control is achieved.

Adults

Seasonal Rhinitis

Treatment

Intranasal Inhalation

Usual initial dose is 2 sprays (100 mcg) in each nostril once daily (total 200 mcg/day).¹ Alternatively, 1 spray (50 mcg) in each nostril twice daily (total 200 mcg/day).^{1 16 17 18 19 27 46 51 55}

Maintenance dose is 1 spray in each nostril (total dose: 100 mcg/day) once adequate symptom control is achieved.^{1 96}

Some patients with seasonal allergic rhinitis may find as needed (prn) use of 200-mcg (100 mcg in each nostril) doses (no more frequently than once daily) to be effective in controlling symptoms.¹ Greater symptom control may be achieved with regular dosing.¹

Prophylaxis†

Intranasal Inhalation

Maintenance dose is 2 sprays (100 mcg) in each nostril daily (200 mcg total).¹²¹

Perennial Rhinitis

Intranasal Inhalation

Usual initial dose is 2 sprays (100 mcg) in each nostril once daily (total dose: 200 mcg/day).¹ Alternatively, 1 spray (50 mcg) in each nostril twice daily (total 200 mcg/day).^{1 16 17 18 19 27 46 51 55}

Maintenance dose is 1 spray in each nostril (total dose: 100 mcg/day) once adequate symptom control is achieved.^{1 96}

Prescribing Limits

No evidence that higher than recommended dosages or increased frequency of administration is beneficial.^{13 15 110 113}

Exceeding the maximum recommended daily dosage may only increase the risk of adverse systemic effects (e.g., HPA-axis suppression, Cushing’s syndrome).¹

Pediatric Patients

Seasonal Rhinitis

Intranasal Inhalation

Adolescents and children ≥4 years of age: Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.¹

Perennial Rhinitis

Intranasal Inhalation

Adolescents and children ≥4 years of age: Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.¹

Adults

Seasonal Rhinitis

Intranasal Inhalation

Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.¹

Perennial Rhinitis

Intranasal Inhalation

Maximum 100 mcg (2 sprays) in each nostril (200 mcg total) daily.¹

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment.¹

Renal Impairment

No specific dosage recommendations for renal impairment.¹

Geriatric Patients

No specific geriatric dosage recommendations.¹

Cautions for Flonase

Contraindications

• 
  

  Known hypersensitivity to fluticasone or any ingredient in the formulation.^{1 110}

  
  

Warnings/Precautions

Warnings

Withdrawal of Systemic Corticosteroid Therapy

Patients being switched from prolonged systemic corticosteroids to intranasal therapy should be monitored carefully since corticosteroid withdrawal symptoms (e.g., joint pain, muscular pain, lassitude, depression), acute adrenal insufficiency, and/or severe symptomatic exacerbation of asthma or other clinical conditions may occur.^{1 115}

Systemic corticosteroid dosage should be tapered, and patients should be carefully monitored during dosage reduction.^{1 115}

Infection, Trauma, or Surgery

Use cautiously, if at all, in patients with clinical tuberculosis or asymptomatic Mycobacterium tuberculosis infections; untreated local or systemic fungal or bacterial infections; systemic viral or parasitic infections; ocular herpes simplex infections; or septal ulcers, trauma, or surgery in the nasal region.¹

Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression

Avoid higher than recommended dosages since suppression of HPA function may occur.¹

Immunosuppression

Although risk with intranasal use is unknown, consider the possibility that corticosteroid-induced immunosuppression could occur.¹ Avoid exposure to varicella and measles in previously unexposed patients.¹

Sensitivity Reactions

Possible immediate hypersensitivity reactions (e.g., wheezing, contact dermatitis, rash, dyspnea, anaphylaxis/anaphylactoid reactions, pruritus, urticaria, angioedema, edema of the face and tongue, and bronchospasm).^{1 112}

General Precautions

Systemic Corticosteroid Effects

Excessive intranasal dosages or use in patients who are particularly sensitive to corticosteroid effects may cause systemic corticosteroid effects (e.g., Cushing’s syndrome, adrenal suppression).¹

Nasopharyngeal Effects

Temporary or permanent loss of smell may occur.¹

Rarely, localized candidal infections of the nose and/or pharynx.^{1 104 105 119} Treat suspected local infection appropriately;^{1 115} may require discontinuance of fluticasone therapy.^{1 17}

Rarely, nasal septal perforations.^{1 110 113 115}

Avoid use until healing occurs in patients with recurrent epistaxis, recent nasal septal ulcers, nasal surgery, or nasal trauma.¹

Ophthalmic Effects

Possible increased IOP.¹

Cataracts, ocular dryness and irritation, conjunctivitis, blurred vision, and glaucoma have been reported.^{1 17 84}

Oral Effects

Temporary or permanent loss of taste may occur.¹

Specific Populations

Pregnancy

Category C.¹

Lactation

Other corticosteroids known to be distributed into milk.^{1 48} Caution if used in nursing women.¹

May cause adverse effects (e.g., growth suppression) in nursing infants if distributed into milk.¹

Pediatric Use

May be a useful therapeutic alternative to oral corticosteroids in children ≥4 years of age with seasonal or perennial allergic rhinitis since intranasal administration is associated with a decreased risk of adverse systemic effects.

Intranasal corticosteroids may reduce growth velocity in pediatric patients.¹ Children 3–9 years of age receiving 200 mcg of fluticasone propionate daily for 1 year did not show evidence of reduction in normal growth velocity.¹ No clinically relevant changes in HPA axis or bone mineral density (as assessed by dual X-ray absorptiometry) observed.¹

Safety and efficacy not established in children <4 years of age.^{1 87}

Geriatric Use

Adverse effect profile similar to profile in younger adults.¹

Common Adverse Effects

Mild, transient nasal burning and stinging,^{1 3 16 17 21 27 46 51 54 55} aftertaste¹ , epistaxis,^{13 16 17 19 21 22 46 51 54 55 112 124} headache,^{1 112 124} nausea and vomiting,^{1 21} abdominal bloating,¹ pharyngitis,^{1 16 17 27 112} cough^{1 124} and asthma symptoms^{1 124} are most common.

Interactions for Flonase

Metabolized by CYP3A4.

Drugs Affecting Hepatic Microsomal Enzymes

Drugs that affect CYP3A4 activity: Potential pharmacokinetic interaction (altered metabolism of fluticasone).¹ Exercise caution when potent CYP3A4 inhibitors are used concomitantly.¹

Specific Drugs

Drug	Interaction	Comments
Corticosteroids	Potential pharmacodynamic interaction (increased the risk of hypercorticism, suppression of the HPA axis, decreased growth rate in children) with concomitant use of other inhaled and/or systemically absorbed corticosteroids1 38 79 84	Concomitant use not recommended
Erythromycin	Does not affect the pharmacokinetics of fluticasone1
Ketoconazole	Possible increase in mean plasma fluticasone concentrations and toxicity1	Exercise caution1
Ritonavir	Increases plasma fluticasone concentrations, resulting in decreased plasma cortisol AUC1 Cushing’s syndrome and adrenal suppression reported1	Concomitant use not recommended unless potential benefit outweighs the risk of adverse effects1

Flonase Pharmacokinetics

Absorption

Bioavailability

Poorly absorbed from the respiratory and GI tracts following nasal inhalation.^{8 51 52}

Systemic bioavailability of less than 2% based on indirect calculations.^{1 7}

Onset

Symptomatic relief usually is evident within 12–48 hours of initiation of therapy in adults and within 36 hours in children.^{1 13 16 27 46 48 51 52}

Optimum effectiveness generally requires 2–4 days in most patients.^{1 13 16 27 46 48 51 52}

Duration

Following discontinuance, symptoms of rhinitis do not recur for 1–2 weeks.^{10 13 16 27 46 48 52 62}

Distribution

Extent

Placental distribution in humans is unknown, but fluticasone crosses the placenta in animals.¹

Distribution into milk unknown, but other corticosteroids are distributed.¹

Plasma Protein Binding

Approximately 91%.^{1 48}

Elimination

Metabolism

Rapidly metabolized in the liver by the CYP3A4.^{1 3 8 48 117}

Elimination Route

Following oral administration, about 87–100% is excreted in the feces, and less than 5% of the dose is excreted in the urine.^{2 14 7 8 48 103}

Half-life

Plasma half-life: about 3 hours after IV administration.^{1 7 8 48 103}

Stability

Storage

Nasal Suspension

4–30°C.¹

Discard the nasal pump spray after 120 sprays.¹

ActionsActions

• 
  

  Potent glucocorticoid and weak mineralocorticoid effects.^{48 110 113 117}

  
  


• 
  

  Local anti-inflammatory and vasoconstrictor effects^{17 22 55 58 63} result from local actions of the deposited inhaled dose on the nasal mucosa.^{1 13 22 56 67}

  
  


• 
  

  Reduces the number of mediator cells (basophils,^{2 5 7 13 17 27 35 46 51 55 57 58} eosinophils,^{2 4 5 7 9 13 17 27 35 46 50 51 55 57 58 60 61 63 116} helper-inducer [CD4⁺, T4⁺] T-cells,^{4 60 116} mast cells,^{7 50 60 61 116} and neutrophils)^{2 7 13 35} in the nasal mucosa. Also reduces nasal reactivity to allergens and release of inflammatory mediators⁶³ and proteolytic enzymes.⁶³

  
  


• 
  

  May inhibit nasal postcapillary venule dilation and permeability.^{22 55 62}

  
  


• 
  

  May facilitate nasomucociliary clearance of nasal secretions.^{22 55 62}

  
  


• 
  

  May decrease nasal turbinate swelling, mucosal inflammation,^{22 55} and nasal hyperreactivity.^{2 4 5 9 10 49}

  
  

Advice to Patients

• 
  

  Proper techniques for assembly and priming of nasal spray pump and for administration and storage of the nasal solution.¹

  
  


• 
  

  Importance of not administering the entire dose (i.e., 2–4 sprays) into a single nostril.¹

  
  


• 
  

  Give patients a copy of the manufacturer’s patient instructions.¹

  
  


• 
  

  Advise patients to cleanse the nasal spray adapter and/or pump at least once weekly.^{6 110 b}

  
  


• 
  

  Importance of shaking containers of nasal spray gently prior to each use.^b

  
  


• 
  

  Importance of discarding the container after 120 actuations or once the expiration date on the label is reached.^{1 b}

  
  


• 
  

  Caution against spraying into eyes or directly on nasal septum.^{1 67 79}

  
  


• 
  

  Advise patients that effects are not immediate; full benefit requires regular use and usually can be achieved in several days.^{1 110}

  
  


• 
  

  Importance of taking as directed and not exceeding prescribed dosage.¹

  
  


• 
  

  Importance of informing clinician if symptoms fail to improve or if symptoms worsen.¹

  
  


• 
  

  Importance of not increasing dosage unless directed by a clinician.¹

  
  


• 
  

  Importance of advising clinician if sneezing or nasal irritation occurs.¹

  
  


• 
  

  Advise that concomitant nasal decongestants and/or oral antihistamines may be needed until effects of fluticasone are optimal.

  
  


• 
  

  If receiving immunosuppressive doses of corticosteroids, importance of avoiding exposure to chickenpox or measles, and if exposed, to notify a clinician.^{1 89 98 99 100}

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.¹

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

  
  


• 
  

  Importance of informing patients of other important precautionary information.¹ (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Fluticasone Propionate

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Nasal	Suspension, for intranasal use only	50 mcg/metered spray	Flonase Nasal Spray (with benzalkonium chloride and phenylethyl alcohol)	GlaxoSmithKline

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Flonase 50MCG/ACT Suspension (GLAXO SMITH KLINE): 16/$85.98 or 48/$249.99

Fluticasone Propionate 50MCG/ACT Suspension (ROXANE): 16/$59.99 or 48/$169.97

Veramyst 27.5MCG/SPRAY Suspension (GLAXO SMITH KLINE): 10/$110.99 or 30/$314.98

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions August 2005. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. GlaxoSmithKline. Flonase (fluticasone propionate) nasal spray 50 mcg prescribing information. Research Triangle Park, NC; 2004 Mar.

2. Bryson HM, Faulds D. Intranasal fluticasone propionate: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in allergic rhinitis. Drugs. 1992; 43:760-75. [IDIS 359172] [PubMed 1379151]

3. Phillipps GH. Structure-activity relationships of topically active steroids: the selection of fluticasone propionate. Respir Med. 1990; 84(Suppl A):19-23. [PubMed 2287791]

4. Masuyama K, Jacobson MR, Rak S et al. Topical glucocorticosteroid (fluticasone propionate) inhibits cells expressing cytokine mRNA for interleukin-4 in the nasal mucosa in allergen-induced rhinitis. Immunology. 1994; 82:192-9. [PubMed 7927488]

5. Konno A, Yamakoshi T, Terada N et al. Mode of action of a topical steroid on immediate phase reaction after antigen challenge and nonspecific nasal hyperreactivity in nasal allergy. Int Arch Allergy Immunol. 1994; 103:79-87. [PubMed 8260854]

6. Allen and Hanburys. Flonase (fluticasone propionate) nasal spray 0.05% patient information. Research Triangle Park, NC. 1994 Sep.

7. Allen and Hanburys, Research Triangle Park, NC: Personal communication.

8. Harding SM. The human pharmacology of fluticasone propionate. Respir Med. 1990; 84(Suppl A):25-9. [PubMed 2287792]

9. Thomas KE, Greenwood L, Murrant N et al. The effects of topical fluticasone propionate on allergen-induced immediate nasal airways response and eosinophil activation: preliminary results. Respir Med. 1990; 84(Suppl A):33-5. [PubMed 2287795]

10. Juliusson S, Holmberg K, K et al. Mast cells and mediators in the nasal mucosa after allergen challenge. Effects of four weeks’ treatment with topical glucocorticoid. Clin Exp Allergy. 1993; 23:591-9. [PubMed 7693314]

11. Bye A. The oral systemic availability of fluticasone propionate in man—preliminary data. Br J Clin Pharmacol. 1993; 36:12-3.

12. Andersson P, Brattsand R, Dahlstrom K et al. Oral availability of fluticasone propionate. Br J Clin Pharmacol. 1993; 36:135-6. [IDIS 318868] [PubMed 8398584]

13. Meltzer EO, Orgel HA, Bronsky EA et al. A dose-ranging study of fluticasone propionate aqueous nasal spray for seasonal allergic rhinitis assessed by symptoms, rhinomanometry, and nasal cytology. J Allergy Clin Immunol. 1990; 86:221-30. [IDIS 287713] [PubMed 2200821]

14. Lozewicz S, Wang J, Duddle J et al. Topical glucocorticoids inhibit activation by allergen in the upper respiratory tract. J Allergy Clin Immunol. 1992; 89:951-7. [IDIS 295962] [PubMed 1583252]

15. van As A, Bronsky E, Grossman J et al. Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis. Ann Allergy. 1991; 67:156-62. [IDIS 287303] [PubMed 1867454]

16. Ratner PH, Paull BR, Findlay SR et al. Fluticasone propionate given once daily is as effective for seasonal allergic rhinitis as beclomethasone dipropionate given twice daily. J Allergy Clin Immunol. 1992; 90:285-91. [IDIS 302398] [PubMed 1527313]

17. van As A, Bronsky EA, Dockhorn RJ et al. Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone diproprionate. J Allergy Clin Immunol. 1993; 91:1146-54. [IDIS 315940] [PubMed 8509578]

18. Dolovich J, O’Connor M, Stepner N et al. Double-blind comparison of intranasal fluticasone propionate, 200mcg, once daily with 200mcg twice daily in the treatment of patients with severe seasonal allergic rhinitis to ragweed. Ann Allergy. 1994; 72:435-40. [IDIS 329397] [PubMed 8179230]

19. Dolovich J, Wong AG, Chodirker WB et al. Multicenter trial of fluticasone propionate aqueous nasal spray in ragweed allergic rhinitis. Ann Allergy. 1994; 73:147-53. [IDIS 334215] [PubMed 8067598]

20. Vargas R, McMahon FG, Dockhorn R et al. An assessment of HPA axis effects of fluticasone propionate aqueous nasal spray using 6-hr ACTH infusion. Clin Pharmacol Ther. 1994; 55:184.

21. Bousquet J, Chanal I, Alquié MC et al. Prevention of pollen rhinitis symptoms: comparison of fluticasone propionate aqueous nasal spray and disodium cromoglycate aqueous nasal spray: a multicenter, double-blind, double-dummy, parallel-group study. Allergy. 1993; 48:327-33. [PubMed 8368459]

22. Haye R, Gomez EG. A multicentre study to assess long-term use of fluticasone propionate aqueous nasal spray in comparison with beclomethasone dipropionate aqueous nasal spray in the treatment of perennial rhinitis. Rhinology. 1993; 31:169-74. [PubMed 8140383]

23. O’shaughnessy KM, Wellings R, Gillies B et al. Differential effects of fluticasone propionate on allergen-evoked bronchoconstriction and increased urinary leukotriene E₄ excretion. Am Rev Respir Dis. 1993; 147:1472-6. [IDIS 315801] [PubMed 8389108]

24. Gustafsson P, Tsanakas J, Gold M et al. Comparison of the efficacy and safety of inhaled fluticasone propionate 200 mcg/day with inhaled beclomethasone dipropionate 400 mcg/day in mild and moderate asthma. Arch Dis Child. 1993; 69:206-11. [IDIS 319533] [PubMed 8215522]

25. Leblanc P, Mink S, Keistinen T et al. A comparison of fluticasone propionate 200 mcg/day with beclomethasone dipropionate 400 mcg/day in adult asthma. Allergy. 1994; 49:380-5. [PubMed 8092438]

26. Fabbri L, Burge PS, Croonenborgh L et al. Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year. Thorax. 1993; 48:817-23. [PubMed 8211872]

27. van Bavel J, Findlay SR, Hampel FC et al. Intranasal fluticasone propionate is more effective than terfenadine tablets for seasonal allergic rhinitis. Arch Intern Med. 1994; 154:2699-704. [IDIS 339502] [PubMed 7993153]

28. Hawthorne AB, Record CO, Holdsworth CD et al. Double blind trial of oral fluticasone propionate v prednisolone in the treatment of active ulcerative colitis. Gut. 1993; 34:125-8. [IDIS 308470] [PubMed 8432442]

29. Zaitoun A, Record CO. Morphometric studies in duodenal biopsies from patients with coeliac disease: the effect of the steroid fluticasone propionate. Aliment Pharmacol Ther. 1991; 5:151-60. [PubMed 1716168]

30. Angus P, Snook JA, Reid M et al. Oral fluticasone propionate in active distal ulcerative colitis. Gut. 1992; 33:711-4. [IDIS 297298] [PubMed 1612492]

31. Carpani de Kaski M, Peters AM, Lavender JP et al. Fluticasone propionate in Crohn’s disease. Gut. 1991; 32:657-61. [IDIS 284152] [PubMed 2060874]

32. Haynes RC Jr. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Gilman AG, Rall TW, Nies AS et al, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 8th ed. New York: Pergamon Press; 1990:1431-1462.

33. Darnell R, Pecoud A, Richards DH. A double-blind comparison of fluticasone propionate aqueous nasal spray, terfenadine tablets, and placebo in the treatment of patients with seasonal allergic rhinitis to grass pollen. Clin Exp Allergy. 1994; 24:1144-50. [PubMed 7889428]

34. Belling U. Once daily treatment with fluticasone propionate aqueous nasal spray or astemizole tablets for seasonal rhinitis. Clin Exp Allergy. 1990; 20(Suppl 1):98.

35. Meltzer EO, Orgel HA, Rogenes PR et al. Nasal cytology in patients with allergic rhinitis: effects of intranasal fluticasone propionate. J Allergy Clin Immunol. 1994; 94:708-15. [IDIS 336956] [PubMed 7930304]

36. Dahl R, Lundback B, Malo JL et al. A dose-ranging study of fluticasone propionate in adult patients with moderate asthma. Chest. 1993; 104:1352-8. [IDIS 322126] [PubMed 8222787]

37. Chervinsky P, van As A, Bronsky EA et al. Fluticasone propionate aerosol for the treatment of adults with mild to moderate asthma. J Allergy Clin Immunol. 1994; 94:676-83. [IDIS 336954] [PubMed 7930300]

38. Wolthers OD, Pedersen S. Short term growth during treatment with inhaled fluticasone propionate and beclomethasone diproprionate. Arch Dis Child. 1993; 68:673-6. [IDIS 315278] [PubMed 8323338]

39. Barnes NC, Marone G, Di Maria GU et al. A comparison of fluticasone propionate, 1 mg daily, with beclomethasone dipropionate, 2 mg daily, in the treatment of severe asthma. Eur Respir J. 1993; 6:877-85. [PubMed 8339809]

40. Ward C, Booth H, Gardiner PV et al. The effect of high dose inhaled fluticasone propionate (FP) on broncho alveolar lavage (BAL) lymphocyte subsets from asthmatic subjects. Eur Respir J. 1993; 6(Suppl 17):585S.

41. Noonan MJ, Chervinsky P, Weisberg SC et al. Fluticasone propionate (FP) aerosol in the treatment of oral corticosteroid dependent asthmatics. Eur Respir J. 1993; 6(Suppl 17):585S.

42. Harding SM, Felstead S. A comparison of the tolerance and systemic effects of fluticasone propionate (FP) and beclomethasone dipropionate (BDP) in healthy volunteers. Eur Respir J. 1988; 1(Suppl 2):196S.

43. Price JF. Comparative data in childhood asthma. Eur Respir J. 1992; 5(Suppl 15):326S.

44. Pauli G, Dietemann A, Desfougères JL et al. Fluticasone propionate is more effective and as safe as nedocromil in the treatment of moderate asthma. Eur Respir J. 1993; 6(Suppl 17):586S.

45. MacKenzie CA, Wales JKH. Clinical experience with inhaled fluticasone propionate-childhood growth. Eur Respir J. 1993; 6(Suppl 17):262S.

46. Nathan RA, Bronsky EA, Fireman P et al. Once daily fluticasone propionate aqueous nasal spray is an effective treatment for seasonal allergic rhinitis. Ann Allergy. 1991; 67:332-8. [IDIS 289494] [PubMed 1897811]

47. Mitchison HC, Al Mardini H, Gillespie S et al. A pilot study of fluticasone propionate in untreated coeliac disease. Gut. 1991; 32:260-5. [IDIS 279109] [PubMed 1901562]

48. Glaxo. Product information form for American hospital formulary service: Flonase (fluticasone propionate nasal spray). Research Triangle Park, NC; 1994 Nov.

49. Scadding GK, Darby YC, Austin CE. Effect of short-term treatment with fluticasone propionate nasal spray on the response to nasal allergen challenge. Br J Clin Pharmacol. 1994; 38:447-51. [IDIS 338763] [PubMed 7893587]

50. Feather I, Wilson S, Smith S et al. The accumulation of mast cells and eosinophils in the nasal mucosa in seasonal allergic rhinitics during natural pollen exposure, is inhibited by prophylactic fluticasone propionate aqueous nasal spray. Am Rev Respir Dis. 1992; 145:A853. [PubMed 1554222]

51. Banov CH, Woehler TR, LaForce CF et al. Once daily intranasal fluticasone propionate is effective for perennial allergic rhinitis. Ann Allergy. 1994; 73:240-6. [IDIS 336185] [PubMed 8092559]

52. Grossman J, Banov C, Bronsky EA. Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis. Pediatrics. 1993; 92:594-9. [IDIS 320553] [PubMed 8414833]

53. Fluticasone Propionate Collaborative Pediatric Working Group. Treatment of seasonal allergic rhinitis with once-daily intranasal fluticasone propionate therapy in children. J Pediatr. 1994; 125:628-34. [IDIS 336611] [PubMed 7931889]

54. LaForce C, Dockhorn R, Findlay S et al. Fluticasone propionate treatment for seasonal allergic rhinitis is safe and effective in adults and adolescents. J Allergy Clin Immunol. 1991; 87:153.

55. Dockhorn RJ, Paull BR, Meltzer EO et al. Once-versus twice-daily fluticasone propionate aqueous nasal spray for seasonal allergic rhinitis. Am J Rhinology. 1993; 7:77-83.

56. Hampel F, Howland W, Martin B et al. The efficacy of fluticasone propionate aqueous nasal spray for treatment of rhinitis is dependent on topical application. J Allergy Clin Immunol. 1994; 93:165.

57. Selner J, Banov C, Boltansky H et al. Fluticasone propionate aqueous nasal spray effectively treats perennial non-alle