Prescribing advice for inhaled fluticasone propionate (Flixotide) has been updated to minimise the risk of systemic adverse effects that occur at high doses, the UK MCA has announced in Current Problems. The updated information includes the following new guidelines, which are to be included in the product information for all inhaled preparations of fluti-casone propionate.
• The starting dosage should reflect the severity of the disease.
• The dosage should be gradually reduced to the lowest dosage at which the patient’s asthma is effect-tively managed.
• Patients with mild asthma should start fluticasone propionate at a dosage of 100µg twice daily, while those with moderate-to-severe asthma should initially receive 250 500µg twice daily.
• More importantly, dosages > 500µg twice daily should only be prescribed to patients with severe asthma in whom an additional clinical benefit is expected and demonstrated by either an improvement in pulmonary function and/or symptom control, or a reduced requirement for oral cortico-steroids. Furthermore, only a consultant physician, or a general practitioner with appropriate experience in the management of asthma, should initiate such a dosage.
Current Problems in Pharmacovigilance 27: 10, Aug 2001.