Flovent hfa how many puffs

Consequently, how many puffs of Flovent should I take? Your doctor may adjust your dose as needed. However, the dose is usually not more than mcg two times per day. Dark orange plastic inhaler with a peach strapcap containing a pressurized metered-dose aerosol canister containing metered inhalations and fitted with a counter. Each actuation delivers 44, , or mcg of fluticasone propionate from the mouthpiece.

Is Flovent dangerous? Always have a rescue inhaler with you to treat sudden symptoms. Why do you have to rinse your mouth after Flovent? Gargling and rinsing your mouth with water after each dose may help prevent hoarseness, throat irritation, and infection in the mouth. However, do not swallow the water after rinsing. Take the inhaler out of the pouch before you use it for the first time. Does Flovent make you gain weight?

A: NO. Your inhaler contains such a low dose of steroids that it will not make you put on weight. Sometimes steroid tablets can make you feel hungry, and eating more will make you start to gain weight. The tablets themselves don't make you gain, so eat your normal amounts while you take them and you should be fine. In general, corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease, route and product of administration, and on patient age and response.

For some products maximum dosage limits have not been specified. Safety and efficacy not established for fluticasone propionate for nasal polyps Xhance. Safety and efficacy have not been established for other formulations. Specific guidelines for dosage adjustments in hepatic impairment are not available; however, caution is recommended in those with moderate or severe hepatic impairment. Patients with hepatic disease who are receiving fluticasone propionate for nasal polyps should be closely monitored.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. For topical dermatologic use only. Not for ophthalmic, oral, or intravaginal use.

Avoid contact with eyes. Patients who fail to respond to topical fluticasone treatment after 2 weeks should be re-evaluated. Once control of the treated condition has been achieved, discontinue fluticasone treatment. Intermittent application may be needed to maintain remission or control of the condition in some cases. The lowest effective maintenance application should be used. Other options include changing to a less potent topical corticosteroid for maintenance and control of inflammation and symptoms.

Wash hands before and after fluticasone application. Use gloves if required by universal precautions. Apply sparingly in a thin film and rub gently into affected area. Restrict application to the active lesions or affected areas and try to avoid normal surrounding skin.

The amount of cream or ointment needed to cover a certain area can be calculated. A 1 gram application of cream covers cm2 of skin. The entire skin surface of the average size adult will be covered by 30 grams of topical steroid cream. Fluticasone propionate preparations generally should not be used with occlusive dressings, including diapers and plastic pants. Instruct patients and caregivers not to bandage, cover, or wrap area in any way that may be occlusive unless recommended by their physician.

Shake well before each use. Instruct the patient on proper inhalation technique. See the inhaler's "Instructions for Use". Flovent HFA should be primed prior to the initial use by releasing 4 sprays into the air, away from the face and other people. The inhaler should also be primed by releasing 1 spray into the air if it has not been used for 7 days or longer or if it is dropped.

For patients unable to coordinate inhalation and actuation, a spacer or valved holding chamber VHC may be beneficial. If a face mask is used, allow 3 to 5 inhalations per actuation.

Administration of fluticasone HFA via the AeroChamber Plus VHC with face mask has been shown to result in higher systemic exposure in patients ages 6 months to 3 years compared to children 4 to 11 years of age who receive the same dose without the VHC or face mask.

Have the patient rinse the mouth thoroughly with water after administration to remove fluticasone deposited in the mouth; they should not swallow the water. The inhaler must be cleaned at least 1 time each week. Remove the canister and cap from the inhaler. Rinse the inhaler with warm water and let it air-dry overnight. To avoid the spread of infection, do not use the inhaler for more than 1 person.

The canister contains a dose counter. The inhaler should be discarded after the counter reads "". Although the canister is still operational and may contain medication, the accuracy of medication delivery cannot be assured.

The patient should contact the pharmacist or provider regarding a refill when the counter reads "". Powder for oral inhalation Flovent Diskus : Prior to initial use, instruct the patient to remove the Diskus device from the moisture-protective foil pouch and to safely throw away the foil pouch.

The Diskus device will be in the closed position. The patient should fill in the "Pouch opened" and "Use by" dates in the blank lines on the label. The "Use by" date for Flovent Diskus 50 mcg is 6 weeks from the date the pouch is opened. The "Use by" date for Flovent Diskus mcg and mcg devices is 2 months from the date the pouch is opened. Open the Diskus device by holding the device in one hand and using the thumb of the other hand to push the thumb grip away as far as it will go until the mouthpiece shows and snaps into place.

Instruct the patient to hold the Diskus device in a level, flat position with the mouthpiece towards them and to slide the lever away from them as far as it will go until it clicks. The number on the dose counter will count down by 1; the Diskus device is now ready to use. To avoid releasing a dose by mistake before the patient is ready to inhale, warn the patient not to close or tilt the Diskus device, not to play with the lever, and not to slide the lever more than once.

Before inhaling the dose, have the patient breathe out as far as they can while holding the Diskus device level and away from their mouth. They should never breathe out into the mouthpiece. Have the patient put the mouthpiece to their lips and breathe in through the mouth quickly and deeply through the Diskus device.

Remove the Diskus device from the mouth, hold the breath for about 10 seconds, or for as long as it is comfortable, and then breathe out slowly. After taking a dose, the patient should close the Diskus device by sliding the thumb grip it back towards them far as it will go. The Diskus device will click shut. The lever will automatically return to its original position. The counter displays how many doses are left. The counter number will count down each time the patient uses the Diskus device.

After 55 doses 23 doses from the sample pack , the patient will see numbers "5" to "0" in red to warn that there are only a few doses left. Powder for oral inhalation Arnuity Ellipta : Administer via oral inhalation.

Instruct the patient to open and prepare the mouthpiece of the fluticasone inhaler and slide the cover down to activate the first dose. The counter counts down by 1 each time the patient opens the cover.

Holding the inhaler mouthpiece level to, but away from, the mouth, the patient should exhale. Then, put the mouthpiece to the lips and have the patient breathe in the dose deeply and slowly. Remove the inhaler from the mouth, hold the breath for about 3 to 4 seconds, and then exhale slowly. Close the inhaler. If the cover is opened and closed without inhaling the medicine, the dose will be lost.

The lost dose will be held in the inhaler, but it will no longer be available to be inhaled. It is not possible to accidentally take a double dose or an extra dose in one inhalation. Routine cleaning of the inhaler is not required; the patient can clean the mouthpiece if needed, using a dry tissue, before the cover is closed.

Discard inhaler after 30 sprays or when the counter reads "0", or when the expiration date has passed. Powder for Oral Inhalation Armonair Digihaler : Each canister is supplied with a white inhaler with the mouthpiece and a green cap that covers the mouthpiece.

Priming is not necessary. Instruct the patient to hold the inhaler upright and open the green cap all the way back until it "clicks" immediately prior to use. The inhaler does not need to be shaken. If a "click" is not heard then the inhaler may not be activated to give the dose of medicine.

Before inhaling the dose, have the patient breathe out as far as they can while holding the DPI device level and away from their mouth. They should never breathe out into the DPI mouthpiece. Instruct the patient to put the mouthpiece to their lips and breathe in through the mouth quickly and deeply through the DPI device without blocking the vent above the mouthpiece. Remove the DPI device from the mouth, hold the breath for about 10 seconds, and then breathe out slowly.

After taking a dose, close the cap; the cap should not be opened until the patient is ready for the next dose. The inhaler contains 60 doses inhalations and will change to red when 20 doses are left. Patients should be instructed to request a refill when the counter reads The inhaler should be discarded after the counter reads "0". Armonair Digihaler contains a built-in electronic module that detects, records, and stores data on inhaler events, including peak inspiratory flow rate.

A mobile app is required for data transmission but is not required for the administration of fluticasone to the patient. Safely dispose of the device by the specified "use by" date or when the counter reads "0", whichever comes first.

General Nasal Administration Information Instruct patient on the proper use of the nasal spray. Ensure that the proper product has been selected. Before using for the first time the unit must be primed.

Keep the sprayer pointed away from patient, other people, and pets. To avoid the spread of infection, do not use the sprayer for more than one person. For fluticasone propionate e. Before first use, pump the activator 6 times until a fine wide spray appears. If the unit has not been used for 7 days, re-prime the unit.

After administration, wipe the nasal applicator with a clean tissue and replace the cap. The nasal applicator should be cleaned at least 1 time each week. To clean, rinse the applicator with warm tap water, taking care not to suck water into the bottle, and allow to dry at room temperature before replacing the cap.

Before first use, prime the unit by first gently shaking and then pressing the bottle 7 times or until a fine mist appears; direct the spray into the air, away from the face.

If the unit has not been used for 7 days, re-prime the unit by shaking and releasing 2 sprays, in the same manner. Fluticasone propionate is delivered into the nose by actuating the pump spray into 1 nostril while simultaneously blowing exhaling into the mouthpiece of the device. To administer, insert the tapered tip of the cone-shaped nosepiece deep into 1 nostril and form a tight seal between the nosepiece and the nostril. Next, place the flexible mouthpiece into the mouth, bending it as necessary to maintain a tight seal.

Blow into the mouthpiece, and while continuing to blow, push the bottle up to actuate the spray pump. Continuing to blow through the mouth, but not inhaling or exhaling through the nose, at the time of actuation is important to achieve intended drug deposition. Repeat the process in the other nostril for a full dose. The unit does not need to be cleaned; if you prefer to clean it, remove the cap and use a clean, dry, lint-free cloth to wipe after each use.

Replace the cap and store in a clean, dry place. For fluticasone furoate e. Before first use, release 6 test sprays into the air away from face. If the cap has been left off the bottle for at least 5 days, or spray has not been used for more than 30 days, prime the pump again until a fine mist appears. After administration, wipe the nozzle with a clean, try tissue. Do not use water to clean the nozzle. Clean the inside of the cap with a clean, dry tissue once weekly.

Discard after sprays, even if the bottle is not empty. Use of fluticasone does not contraindicate administration of live-virus vaccines. According to the Advisory Committee on Immunization Practices ACIP , administration of live-virus vaccines is safe and effective when steroid therapy is administered topically or by inhalation. Fluticasone is contraindicated for use in anyone who is hypersensitive to the medication or any components of the respective products.

Although true corticosteroid hypersensitivity is rare, patients who have demonstrated a prior hypersensitivity reaction to fluticasone should not receive any form of fluticasone. It is possible, though also rare, that such patients will display cross-hypersensitivity to other corticosteroids. It is advisable that patients who have a hypersensitivity reaction to any corticosteroid undergo skin testing, which, although not a conclusive predictor, may help to determine if hypersensitivity to another corticosteroid exists.

Such patients should be carefully monitored during and following the administration of any corticosteroid. Fluticasone inhalation powders Flovent Diskus, Armonair Digihaler, and Arnuity Ellipta are contraindicated in patients with severe milk protein hypersensitivity; these formulations contain lactose and have been associated, rarely, with anaphylactoid reactions. Inhaled formulations of fluticasone are contraindicated for the primary treatment of patients with status asthmaticus or other types of acute bronchospasm for which intensive therapy is warranted.

Patients should be advised that fluticasone is not to be used as a bronchodilator and is not indicated for relief of acute bronchospasm. Although inhaled corticosteroids ICSs are not indicated for primary treatment of an acute exacerbation, they may be initiated at any time during an exacerbation for patients not using long-term control therapy. An ICS may also be continued during an exacerbation for patients previously using the drug for chronic control.

Systemic absorption of topical or inhaled corticosteroids, like fluticasone, has produced reversible hypothalamic-pituitary-adrenal HPA suppression, manifestations of Cushing's syndrome, hyperglycemia, and glycosuria in some patients.

Use fluticasone with caution in patients with underlying Cushing's syndrome. Conditions which increase systemic absorption of topical corticosteroids include use over large surface areas, prolonged use, use in areas where the epidermal barrier is disrupted i. Patients receiving large doses of a potent topical corticosteroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression.

Recovery of HPA axis function is generally prompt and complete upon discontinuation of the topical corticosteroid. Use of intranasal corticosteroids in susceptible individuals or in excess of recommended dosing may result in hypercorticism and adrenal suppression.

In the event of such complications, the drug should be slowly discontinued. Although the risk of developing HPA suppression is very low with orally inhaled fluticasone, patients should, nevertheless, be monitored for this possibility. If HPA suppression occurs, patients will require systemic corticosteroids during periods of physiologic stress. If surgery is required, patients should notify all health care providers that they have received inhaled corticosteroids within the last 12 months.

Infrequently, signs and symptoms of corticosteroid withdrawal may occur, requiring supplemental systemic corticosteroids. Fluticasone should not be substituted for systemic corticosteroid administration because the amount of inhaled fluticasone that reaches the systemic circulation is insufficient to replace orally administered corticosteroids.

Deaths due to adrenal insufficiency have been reported in asthma patients during and following such a transfer. Topical and inhaled corticosteroids, such as fluticasone, should be used with caution in patients with diabetes mellitus. Exacerbation of diabetes may occur with systemic absorption of the topical corticosteroid. Use of topical corticosteroids may further delay healing of skin ulcers in diabetic patients.

As with any long-term topical treatment of the nasal cavity, patients using fluticasone intranasally over several months or longer should be examined periodically for possible changes in the nasal mucosa. Further, because of the inhibitory effect of corticosteroids on wound healing, patients who have experienced recent nasal septal perforation or ulcer, nasal surgery, or nasal trauma should not use a nasal corticosteroid until healing has occurred.

Patients receiving fluticasone nasal sprays should avoid spraying the inhaler directly on the septum center of the nose. The incidence or course of acute viral or bacterial infection is probably minimally affected by inhaled corticosteroids in most immunocompetent individuals.

However, the use of inhaled or application of topical fluticasone in the presence of infection, including tuberculosis of the skin, active or latent tuberculosis of the respiratory tract, fungal infection, systemic parasitic infection, ocular herpes simplex, and cutaneous or systemic viral infection e.

Because of the potential for worsening infection, fluticasone therapy may need to be interrupted during some active infections. Chickenpox and measles can have a more serious or even fatal course in susceptible children using corticosteroids; the exact risk associated with inhaled or topical fluticasone is unclear. If an unimmunized patient is exposed to chickenpox or measles, proper prophylaxis may be indicated. Corticosteroid therapy can reactivate tuberculosis and should not be used except when chemoprophylaxis is instituted concomitantly.

The use of nasal or orally inhaled fluticasone may result in localized fungal infection of the nose, mouth, and pharynx with Candida albicans. Instruct patients to rinse their mouth after each use of orally inhaled fluticasone to minimize risk. If oropharyngeal candidiasis develops, it should be treated with appropriate local or systemic antifungal therapy while still continuing fluticasone therapy; temporary interruption of respiratory inhaler use should only be done under close medical supervision.

Patients using fluticasone nasal sprays for extended periods i. Detrimental effects on bone metabolism are expected to be much lower with inhaled compared to systemically-administered corticosteroids. A 2-year study of fluticasone inhalation aerosol 88 or mcg twice daily in asthma patients found no statistically significant changes in bone mineral density BMD via dual-energy x-ray absorptiometry DEXA at the lumbar spine.

However, some data suggest that high-dose inhaled steroids may also decrease bone formation and increase resorption, and decreases in bone mineral density have been reported in patients receiving long-term therapy of inhaled corticosteroids. Patients receiving inhaled respiratory steroids, such as fluticasone, may be at increased risk of bone loss compared to healthy individuals; compounding risk factors include preexisting osteopenia, prolonged immobilization, family history of osteoporosis, postmenopausal status, advanced age, tobacco smoking, malnutrition, and use of other medications that may reduce bone mass.

Patients with these risk factors should be monitored and treated with established standards of care. Reported clinical experience with fluticasone administered intranasal or via oral respiratory inhalation has not identified differences in responses between geriatric and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

No dosage adjustments are needed based on geriatric age alone. The OBRA guidelines caution that orally inhaled corticosteroids, such as fluticasone, can cause throat irritation and oral candidiasis, particularly if the mouth is not rinsed after administration. Pharmacokinetic studies have shown that following intranasal and respiratory inhalation administration of fluticasone, most of the drug is absorbed after being swallowed and undergoes extensive first-pass metabolism through the liver.

Hepatic impairment may lead to accumulation of fluticasone in plasma. Therefore, patients with hepatic disease should be closely monitored when receiving nasal or orally inhaled fluticasone. As with other potent fluorinated topical corticosteroids, fluticasone creams and ointments should not be used to treat acne vulgaris, acne rosacea, or perioral dermatitis.

Fluticasone may aggravate these conditions. Fluticasone topical preparations are not recommended to be applied to the face. Topical corticosteroids should be used for brief periods or under close medical supervision in patients with evidence of pre-existing skin atrophy, especially the elderly. Purpura and skin lacerations that may raise the skin and subcutaneous tissue from deep fascia may be more likely to occur with the use of topical corticosteroids in geriatric patients.

Use fluticasone preparations cautiously in patients with markedly impaired circulation or peripheral vascular disease due to the potential for skin ulcer.

Use of lower potency topical corticosteroids may be necessary in some patients. Care should be taken to avoid ocular exposure and use of any fluticasone product topical, nasal, or inhaled around the eyes as cases of visual impairment and ocular hypertension have been reported with topical and inhaled corticosteroids.

Take care during administration not to expose the eyes. Also, glaucoma, increased intraocular pressure, and cataracts have been reported with long-term use of nasal and inhaled corticosteroids. Cataracts and glaucoma have been reported during postmarketing experience with the use of topical corticosteroids. Patients with a change in vision or a history of increased intraocular pressure, glaucoma, or cataracts should be closely monitored during corticosteroid therapy.

Consider referral to an ophthalmologist in patients who develop ocular symptoms or who use fluticasone long term. Fluticasone lotion and cream should not be used in individuals with formaldehyde hypersensitivity.

In these patients, the use of fluticasone may prevent healing or worsen dermatitis. The lotion and cream formulations contain the excipient imidurea, which releases formaldehyde as a breakdown product. Formaldehyde may cause allergic sensitization or irritation upon contact with the skin. The safety and efficacy of intranasal fluticasone furoate i. The safety and efficacy of intranasal fluticasone propionate Xhance has not been established in pediatric patients under the age of 18 years.

Growth inhibition has been observed in some children following therapy with high-dose fluticasone propionate inhalations. Children receiving fluticasone respiratory inhalations should be monitored closely for growth inhibition; the effect of fluticasone on final adult height is not known. There is some evidence indicating that intranasal corticosteroids may also cause reduced growth velocity in children. However, data from a 1-year, placebo-controlled trial in children 3 to 9 years of age with allergic rhinitis receiving fluticasone propionate nasal spray Flonase showed no statistically significant adverse effect on growth; no evidence of clinically significant effects on HPA axis function or bone mineral density were observed.

Data from a 1-year, placebo-controlled growth study in children 5 years to 8. Routine monitoring of growth in children receiving intranasal corticosteroids as well as using the lowest effective dose to minimize systemic effects is recommended.

Topical fluticasone preparations are generally not recommended in pediatric patients except where the benefits of treatment would outweigh the potential risks of therapy. Fluticasone ointment e. Children and infants may absorb proportionally larger amounts of topical corticosteroids due to a larger skin surface area to body weight ratio, and therefore are more susceptible to developing systemic toxicity, especially with high-potency products.

Hypothalamic-pituitary-adrenal HPA axis suppression, Cushing's syndrome, and increased intracranial pressure have been reported in children receiving topical corticosteroid creams and ointments.

There are no randomized clinical studies of fluticasone during pregnancy; there are clinical considerations with the use of fluticasone in pregnant women. Fluticasone should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus. Infants born to mothers taking substantial corticosteroid doses during pregnancy should be monitored for signs of hypoadrenalism. Available data from published literature on the use of inhaled or intranasal fluticasone propionate in pregnant women have not reported a clear association with adverse developmental outcomes.

Fetal abnormalities have been reported in the off-spring of mice, rats, and rabbits exposed to the medications during gestation. When inhaled fluticasone propionate was administered to rats, fetal body weight was decreased, but teratogenicity was not induced at a maternal toxic dose approximately 0.

Experience with oral corticosteroids suggests that rodents are more prone to teratogenic effects from corticosteroid exposure than are humans.

Inhaled corticosteroids are often preferred over systemic corticosteroids when use cannot be avoided for the management of asthma during pregnancy. Low-dose inhaled corticosteroids are considered first line therapy for control of mild persistent asthma during pregnancy according to the guidelines of the National Asthma Education and Prevention Program NAEPP Asthma and Pregnancy Working Group.

Data on the use of medium to high dose inhaled corticosteroid during pregnancy are limited. However, dose titration may be considered for those with moderate to severe persistent asthma, preferably using budesonide. Due to the availability of safety information during pregnancy, budesonide is preferred over other inhaled corticosteroids. However, there are no data to indicate safety concerns with other inhaled corticosteroids, and maintaining a previously established treatment regimen may be more beneficial to the patient.

Selection of any pharmacologic treatment for asthma control during pregnancy should include the specific needs of the patient, based on an individual evaluation, and consideration of the potential benefits or risks to the fetus. Similarly, other fluticasone formulations, such as intranasal fluticasone, should be avoided unless the potential therapeutic benefit justifies the added risk to the fetus. Fluorinated topical corticosteroid creams and ointments, like fluticasone, are not recommended for use in pregnancy.

Lower potency topical corticosteroids are usually used, if needed. Fluticasone via inhalation typically results in low systemic concentrations; therefore, the amount excreted into breast-milk after inhalation or nasal use is expected to be very low.

Reviewers and an expert panel consider inhaled and oral corticosteroids acceptable to use during breast-feeding. Low-dose inhaled corticosteroids are considered first line therapy for control of mild persistent asthma during lactation. Due to greater availability of data, budesonide is the preferred agent in this population.

However, there are no data to indicate safety concerns with other inhaled corticosteroids and maintaining a previously established treatment regimen may be more beneficial to the patient. It is not known whether topical administration of fluticasone could result in sufficient systemic absorption to produce detectable quantities in breast milk.

However, most dermatologists stress that topical corticosteroids can be safely used during lactation and breast-feeding. If applied topically, care should be used to ensure the infant will not come into direct contact with the area of application, such as the breast. Increased blood pressure has been reported in an infant whose mother applied a high potency topical corticosteroid ointment directly to the nipples.

Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. Patients that apply topical fluticasone to exposed portions of the body should avoid excessive sunlight UV exposure from either natural or artificial sources e. Abatacept: Moderate Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients.

Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection.

While there is controversy regarding the ulcerogenic potential of corticosteroids alone, concomitant administration of corticosteroids with aspirin may increase the GI toxicity of aspirin and other non-acetylated salicylates.

Withdrawal of corticosteroids can result in increased plasma concentrations of salicylate and possible toxicity. Although some patients may need to be given corticosteroids and NSAIDs concomitantly, which can be done successfully for short periods of time without sequelae, prolonged coadministration should be avoided. Re-evaluate if inadequate control.

Maintain regular regimen. Systemic infections eg, fungal, bacterial, viral, parasitic. Ocular herpes simplex.

If exposed to chickenpox or measles, consider immune globulin or antiviral prophylactic therapies. Monitor for adrenal insufficiency when transferring from systemic steroids. Reevaluate periodically. Monitor for hypercorticism and HPA axis suppression if occurs, discontinue gradually , growth in children, IOP, glaucoma, or cataracts.