An inhaled corticosteroid (ICS) that is a cornerstone of persistent asthma management. Fluticasone propionate (Flovent) and fluticasone furoate (Arnuity) deliver potent topical anti-inflammatory effects directly to the airways with minimal systemic absorption. Classified as the preferred controller therapy for mild-to-severe persistent asthma in all age groups. Reduces airway inflammation, hyperresponsiveness, exacerbation frequency, and improves lung function.
Improves lung function (FEV1) and symptom control9
Reduces airway hyperresponsiveness
Low systemic absorption minimizes steroid side effects
What to watch for
Oral candidiasis (thrush), preventable by rinsing mouth after use
Dysphonia (hoarseness)
Pharyngitis and cough
Known hypersensitivity to fluticasone or any component1,2
Primary treatment of acute asthma attack or status asthmaticus (not a rescue inhaler)1,2
The bottom line
Evidence rating strong. Most-documented uses: first-line controller for persistent asthma (all severity levels), reduces asthma exacerbations and er visits, improves lung function (fev1) and symptom control. 10 sources indexed (2004–2022), with 2 interaction records on file.
The science
How it works, mechanistically.
Core mechanism
Binds to intracellular glucocorticoid receptors in airway epithelial cells, inflammatory cells, and structural cells. The activated receptor-steroid complex translocates to the nucleus and modulates gene transcription: upregulating anti-inflammatory proteins (lipocortin-1, IL-10, IkB-alpha) and suppressing pro-inflammatory mediators (cytokines IL-1/IL-6/IL-8/TNF-alpha, chemokines, adhesion molecules, and enzymes like COX-2 and iNOS). This reduces eosinophilic inflammation, mast cell degranulation, mucus hypersecretion, and airway remodeling over weeks of consistent use.
Class
Inhaled Corticosteroid
Absorption
Fat-soluble; take with food
Dosing
Dosing & protocol.
Common range
Flovent HFA: 88-440 mcg BID (adults); Arnuity Ellipta: 100-200 mcg once daily; dose titrated to lowest effective dose for asthma control (as prescribed by your physician)
Recommended form
Metered-dose inhaler (MDI) or dry powder inhaler (DPI)
Delivered directly to the lungs via inhalation. Oral bioavailability is <1% (extensive first-pass metabolism). Systemic absorption primarily from lung deposition. Rinse mouth after use to prevent oral candidiasis and dysphonia.5,8
Depletions
What it depletes.
Nutrients this medication can lower over time, and what to replace.
Calcium
Mild
Long-term or high-dose inhaled corticosteroid exposure can reduce bone formation and contribute to poorer calcium balance.
Replace CalciumMonitor Bone density trend + serum calcium when indicatedOnset Usually over months to years of high-dose therapy
Safety
Full safety detail.
Side effects
Oral candidiasis (thrush), preventable by rinsing mouth after use
Dysphonia (hoarseness)
Pharyngitis and cough
Headache
Adrenal suppression (with high doses or prolonged use)
Reduced bone mineral density (with chronic high-dose use)
Growth suppression in children (small, generally clinically insignificant)
Contraindications
Known hypersensitivity to fluticasone or any component1,2
Primary treatment of acute asthma attack or status asthmaticus (not a rescue inhaler)1,2
Moderate-to-severe bronchiectasis with active fungal infection
Untreated systemic fungal, bacterial, viral, or parasitic infections
Schisandra has human evidence of CYP3A inhibition, and fluticasone is highly dependent on CYP3A metabolism. Strong CYP3A inhibition has caused adrenal suppression and Cushing syndrome with inhaled fluticasone, so Schisandra could increase systemic steroid exposure in high-risk use.
Recommendation: Do not add concentrated Schisandra extract to chronic or high-dose inhaled fluticasone without clinician review. Monitor for easy bruising, facial rounding, weight gain, high glucose, or fatigue that could suggest adrenal suppression.
St. John's Wort can induce CYP3A4, and fluticasone is cleared primarily by CYP3A4. Induction may lower systemic and possibly airway steroid exposure, which can reduce asthma or COPD controller effectiveness in some patients.
Recommendation: Avoid starting St. John's Wort while relying on inhaled fluticasone for disease control unless your clinician agrees. If combined, monitor symptoms, peak flow if used, rescue inhaler use, and exacerbations after any St. John's Wort start or stop.
Maneechotesuwan K, Singh D, Fritscher LG et al.. Impact of inhaled fluticasone propionate/salmeterol on health-related quality of life in asthma: A network meta-analysis. Respiratory medicine. 2022
Masoli M, Weatherall M, Holt S et al.. Inhaled fluticasone propionate and adrenal effects in adult asthma: systematic review and meta-analysis. The European respiratory journal. 2006
Dyer MJ, Halpin DM, Stein K. Inhaled ciclesonide versus inhaled budesonide or inhaled beclomethasone or inhaled fluticasone for chronic asthma in adults: a systematic review. BMC family practice. 2006
Masoli M, Weatherall M, Holt S et al.. Systematic review of the dose-response relation of inhaled fluticasone propionate. Archives of disease in childhood. 2004
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