Fluticasone propionate is a synthetic corticosteroid with clinical applications in the treatment of asthma, allergy symptoms, non-allergic rhinitis, and dermatologic conditions. Fluticasone propionate is a potent agonist of the glucocorticoid receptor (GR). Like many of the synthetic corticosteroids, fluticasone propionate demonstrates minimal activity at the mineralocorticoid receptor. Binding of the GR results in receptor dimerization and nuclear translocation, leading to transcription of glucocorticoid responsive elements. Upregulation of these genes increases the production and release of anti-inflammatory cytokines, chemokines, and adhesion molecules. Glucocorticoids also appear to inhibit the transcription of pro-inflammatory genes via interactions with other transcription factors in the cytoplasm and nucleus.
Fluticasone propionate nasal spray is approved for the treatment of allergic and non-allergic seasonal rhinitis and allergy symptoms, and is available in generic forms and over-the-counter. Inhaled formulations of the drug are often prescribed as add-on therapy for asthma unresponsive to bronchodilators alone. Fluticasone propionate is also available in topical formulations for atopic dermatitis and pruritic skin lesions.
Fluticasone propionate generally demonstrates little systemic absorption following intranasal, inhaled, or dermatologic drug administration. Prolonged use, however, can result in local and systemic adverse effects including hypercorticism and hyperglycemia, osteoporosis and avascular necrosis, cataracts and glaucoma, hypothalamic-pituitary axis (including adrenal) suppression, and eosinophilia (inhaled formulation).
A closely related drug with a furoate (rather than propionate) ester substituent on the fluticasone base is also approved for the treatment of persistent asthma in the inhaled form, and seasonal rhinitis in the intranasal form.
In Plain English
Fluticasone propionate alters how your cells read DNA and make proteins. This results in fewer inflammatory molecules and helps get rid of runny nose, asthma attacks, and some types of rashes.
Figure 1. Fluticasone propionate (FP) intranasal spray clinical considerations at a glance.
Figure 2. Fluticasone propionate inhaled powder clinical considerations at a glance.
Figure 3. Fluticasone propionate topical cream/ointment/lotion considerations at a glance
- For allergic rhinitis: https://www.ncbi.nlm.nih.gov/pubmed/8509578
- For seasonal allergy-associated ocular sxs: https://www.ncbi.nlm.nih.gov/pubmed/14619333
Fluticasone propionate in the News
- 2017 NPR: https://www.npr.org/sections/health-shots/2017/04/05/522735518/emergency-room-doctors-are-picking-noses-for-drug-delivery-that-is
- Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
- Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 May 21.
- “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRx, http://www.goodrx.com
- “DailyMed.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/.