Fluticasone Propionate
Fluticasone propionate (trifluorinated glucocorticoid)
Also known as: Flovent · Advair Diskus · Cutovate · Flixotide · Flixonase · Flutivate · CCI-18781 · fluticasoni propionas
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Adjunctive treatment of chronic tracheobronchial disease (excessive side effects from oral steroids) | 110 microgram or 220 microgram (1 puff) | Inhalation | q12h | — | 🌎 NA |
| Adjunctive treatment of chronic tracheobronchial disease | 2 puffs of the 220 micrograms/puff MDI | Inhalation | q12h | — | 🌎 NA |
- Adjunctive treatment of chronic tracheobronchial disease (excessive side effects from oral steroids): Use a delivery device (e.g., AeroDawg). Ensure a tightly fitting face mask and count 7-10 respirations after actuating the MDI into the spacer.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Treatment of feline 'asthma' | one puff of the 44 micrograms/puff MDI | Inhalation | q12h | — | 🌎 NA |
| Feline asthma (signs occurring more than once per week) | one puff of 110 micrograms fluticasone MDI | Inhalation | q12h | — | 🌎 NA |
- Treatment of feline 'asthma': Initially try this dose. Study showed 44, 110, and 220 mcg all significantly reduced eosinophils in airway lavage fluid.
- Feline asthma (signs occurring more than once per week): Use a delivery device (e.g., AeroKat) with a spacer. Cats with more serious disease may require the 220 micrograms MDI. Breathe in and out 7-10 times with mask in place. Give prednisolone at 1-2 mg/kg PO twice daily for 5-7 days initially, then taper over 2-3 months.
Horses
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Inflammatory airway disease (IAD) in young racehorses | Weeks 1 and 2: 2200 micrograms (10 puffs) twice daily. Weeks 3 and 4: 2200 micrograms (10 puffs) once daily. | Inhalation | q12h then q24h | 4 weeks | 🌎 NA |
| Moderate recurrent airway obstruction (RAO/heaves) | Week 3: 2200 micrograms (10 puffs) twice daily. Week 4: 2200 micrograms (10 puffs) once daily. End of 4 weeks (if good response): 2200 micrograms (10 puffs) once every other day. | Inhalation | q12h, then q24h, then EOD | Maintenance | 🌎 NA |
| Prevention of exacerbations of RAO | 6 mg | Inhalation | q12h | — | 🌎 NA |
- Inflammatory airway disease (IAD) in young racehorses: Use a delivery device (e.g., Aeromask or Equine-haler). Recheck in 4 weeks to determine further treatment.
- Moderate recurrent airway obstruction (RAO/heaves): Begin stringent environmental control and systemic prednisone. Add fluticasone at week 3 with salmeterol 210 mcg (10 puffs).
- Prevention of exacerbations of RAO: Using the EquineHaler. Highly likely that a lower dose can be used.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Fluticasone propionate is a potent, synthetic glucocorticoid primarily utilized in veterinary medicine as an inhaled aerosol.
- Primary Uses: It is highly effective for managing chronic inflammatory airway diseases, such as feline asthma, chronic tracheobronchial disease in dogs, and recurrent airway obstruction (RAO/heaves) or inflammatory airway disease (IAD) in horses. Nasal formulations may also be used for allergy-related chronic rhinosinusitis.
- Clinical Advantage: Because it is delivered directly to the respiratory mucosa via a metered-dose inhaler (MDI) and a species-specific spacer, it provides excellent local anti-inflammatory effects while significantly minimizing the systemic side effects typically associated with oral or injectable steroids.
- Potency: It possesses an affinity for human glucocorticoid receptors that is 18 times greater than that of dexamethasone.
Mechanism of action
Fluticasone exerts its effects by binding to cytosolic glucocorticoid receptors in the respiratory mucosa.
Mechanism Pathway: Receptor binding → Translocation of the receptor-ligand complex to the nucleus → Alteration of gene transcription → Inhibition of pro-inflammatory mediators (such as cytokines, prostaglandins, and leukotrienes) → Decreased airway inflammation, reduced mucosal edema, and lowered airway hyperreactivity.
Note: The drug is highly lipophilic, allowing for prolonged retention in lung tissue, and undergoes extensive first-pass metabolism, which limits systemic bioavailability if swallowed.
Safety & warnings
Contraindications
- Hypersensitivity to fluticasone
- Acute bronchospasm or status asthmaticus (not a rescue inhaler)
Adverse effects
- Pharyngitis (reported in humans)
- Upper respiratory infections (reported in humans)
- Hypothalamic-pituitary-adrenal (HPA) axis suppression (rare with inhaled therapy, but possible with chronic high doses)
- Cushingoid effects (with chronic overdosage)
- Paradoxical bronchospasm (rare)
Precautions
When transferring patients from systemic steroid therapy to inhaled steroids, wean slowly off systemic therapy to avoid acute adrenal insufficiency. Prepare to cover patients with additional systemic steroid therapy during periods of acute stress, severe asthma attacks occurring during the withdrawal stage, or after transfer to inhaled steroids. Fluticasone is not useful for acute bronchospasm. Use with caution in nursing dams. FDA Category C for pregnancy; use only when benefits clearly outweigh risks.
Drug interactions
Inhibits CYP3A4 isoenzymes; theoretically could increase systemic fluticasone levels.
May decrease the metabolism of fluticasone, potentially increasing systemic exposure.
Monitoring
- Clinical efficacy (reduction in coughing, wheezing, or respiratory effort)
- Signs of HPA axis suppression or cushingoid changes (rare with inhaled therapy)
Pharmacokinetics
Absorption
In humans, when administered via the lung, about 30% is absorbed into the systemic circulation. Peak plasma concentrations of 0.1 to 1 ng/mL seen after 880 mcg dose.
Distribution
Volume of distribution averages 4.2 L/kg. It is 91% bound to human plasma proteins.
Metabolism
Metabolized via hepatic cytochrome P450 3A4 isoenzymes to a metabolite with negligible pharmacologic activity.
Elimination
Terminal elimination half-life is about 8 hours (in humans). Most of the drug is excreted in the feces as parent drug and metabolites.
Overdose
Acute overdoses of this medication are unlikely to require treatment. Chronic overdoses could result in significant HPA axis suppression and cushingoid effects.
Available products
Formulations
- Metered dose inhaler (MDI) aerosol
- Dry powder for inhalation
- Nasal spray/solution
- Topical cream and ointment
Human-labeled
- Fluticasone Propionate aerosol for inhalation: 44 mcg, 110 mcg, and 220 mcg per actuation (Flovent HFA)
- Fluticasone Propionate/Salmeterol Powder for Inhalation: 100/50 mcg, 250/50 mcg, 500/50 mcg (Advair Diskus)
- Fluticasone Propionate/Salmeterol Aerosol for Inhalation: 45/21 mcg, 115/21 mcg, 230/21 mcg
- Nasal solutions, topical creams, and ointments
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store between 2-30°C (36-86°F); protect from freezing and direct sunlight. Store canister with the mouthpiece down.
Client information
Important: This medication is a preventative controller for airway inflammation. It is not a rescue inhaler for acute asthma attacks.
- Preparation: Shake the canister well before using. If possible, bring the canister to room temperature before administration.
- Administration: Must be used with a spacer device appropriate for your pet's species (e.g., AeroKat®, AeroDawg®). Place the facemask gently over the animal's mouth and nose, press the inhaler to fill the spacer, and allow the animal to breathe with the mask on for 7 to 10 normal breaths before removing it.
- Storage: Do not puncture or incinerate the can.
- Duration: A standard prescription of one puff twice a day will last approximately 2 months.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.