Flixotide Evohaler

How does it work?

• Flixotide evohaler, accuhaler and nebules all contain the active ingredient fluticasone propionate, which is a type of medicine known as a corticosteroid.
• Corticosteroids are hormones that are produced naturally by the adrenal glands. They have many important functions, including control of inflammatory responses. Fluticasone is a synthetic corticosteroid and is used to decrease inflammation in the lungs. (NB. Corticosteroids are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders.)
• When fluticasone is inhaled into the lungs it is absorbed into the cells of the lungs and airways. Here it works by preventing the release of certain chemicals from the cells. These chemicals are important in the immune system and are normally involved in producing immune and allergic responses that result in inflammation. By decreasing the release of these chemicals in the lungs and airways, inflammation is reduced.
• In asthma, the airways tighten due to inflammation and can also be blocked by mucus. This makes it difficult for air to get in and out of the lungs. By preventing the inflammation and excess mucus formation, fluticasone helps prevent asthma attacks. It is not used to treat an asthma attack.

How is this medicine taken?

Fluticasone is taken using an inhaler device. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if the medicines were taken by mouth.

Flixotide inhalers are usually used regularly twice a day. However, you should follow the instructions given by your doctor regarding when to use your inhaler and how many inhalations you should use each day. Don't exceed the prescribed dose.

It is very important to learn how to use your inhaler correctly, as otherwise you won't be breathing the right dose of medicine into your lungs. Instructions will be provided with your inhaler. However, your doctor, nurse or pharmacist can also show you how to use your inhaler and can check that you are using it correctly.

Flixotide is available as two different types of inhaler device; the evohaler and the accuhaler.

• Flixotide evohaler is a metered dose inhaler (sometimes called an MDI or aerosol inhaler) that delivers the medicine as a fine spray or mist. With this inhaler you have to co-ordinate pressing down the canister and breathing in the spray. Follow this link for general instructions on how to use a metered dose inhaler. Flixotide evohaler can also be used with a spacer device such as the Volumatic.
• Flixotide accuhaler is a dry powder inhaler. It comes pre-loaded with blisters containing individual doses of the medicine as a powder. To take a dose you have to slide the lever on the inhaler. This opens a blister inside the inhaler, making a dose ready for you to inhale. You then breathe out fully, put the mouthpiece to your lips and breathe in steadily and deeply through your mouth. More detailed instructions are provided with the accuhaler.
• Inhaled corticosteroids can sometimes cause a fungal infection in the mouth called oral thrush. To minimise the chances of this you should rinse your mouth with water or clean your teeth after inhaling each dose. Using a spacer device can also help avoid this problem. Consult your doctor if you develop white patches in your mouth or throat, as these are symptoms of thrush and it may need to be treated.
• If you forget to take a dose, just take your next dose when it is due. Do not take a double dose to make up for a missed dose.
• Do not stop using your inhaler regularly, even if you don't have any symptoms, unless advised to by your doctor.
• Flixotide nebules are used with a machine called a nebuliser that converts the liquid medicine inside the nebules into particles that can be inhaled. It is used to deliver higher doses of the medicine than other inhalers. With Flixotide is best to use a mouthpiece, rather than a face-mask, to inhale the medicine from the nebuliser, as prolonged use of a face-mask can cause thinning of the facial skin that is exposed to the nebulised steroid. If it is necessary to use a face-mask, the exposed skin should be protected using a barrier cream, or the face should be thoroughly washed after treatment.

Use with caution in

• People with a history of tuberculosis infection in the lungs.
• Diabetes.

Not to be used in

• Flixotide preparations are not licensed for children under four years of age. In addition, the higher strength preparations (Flixotide accuhaler 250mcg and 500mcg, Flixotide evohaler 250mcg, and Flixotide nebules 2mg/2ml) are not licensed for children under 16 years of age.
• This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
• If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• It is important that asthma is well controlled in pregnant women because severe asthma attacks can be dangerous to the pregnancy. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. The manufacturer states that Flixotide should be used with caution during pregnancy. However, it is generally considered that asthma inhalers can be taken as usual during pregnancy. For further medical advice talk to your doctor or pharmacist.
• It is not known if fluticasone passes into breast milk. However, in general, asthma inhalers can be used as normal during breastfeeding, because the amount of medicine that passes into the breast milk after using an inhaler is negligable and unlikely to harm the baby. Seek further medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Very common

• Thrush infection of the mouth and throat (oral thrush). This can usually be avoided by rinsing the mouth out with water and spitting it out immediately after each time you use your inhaler. If you do get oral thrush your doctor can prescribe an antifungal medicine to treat it.

Common 

• Hoarse voice.
• Bruising.

Very rare 

• Indigestion.
• Pain in the joints.
• Raised blood sugar level (hyperglycaemia).
• Unexpected narrowing of the airways.
• Systemic steroid effects such as Cushing's syndrome (moon-shaped face), suppression of the adrenal glands, cataracts, glaucoma, slowed growth in children and adolescents or decreased bone mineral density may occur, usually only after taking high doses for prolonged periods of time - see warning section above.
• Anxiety, depression or sleep disturbances.
• Behavioural changes, including hyperactivity, aggression and irritability (mostly in children).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

The following medicines may increase the amount of fluticasone that is found in the bloodstream after inhaling the medicine:

• itraconazole
• protease inhibitors for HIV infection, such as ritonavir
• telaprevir.

These medicines can therefore increase your exposure to fluticasone and so increase the risk of side effects on the rest of the body. These are called systemic side effects, for example, decreased production of natural steroid hormones by the adrenal glands (adrenal suppression) and Cushing's syndrome.

Due to this risk, Flixotide is not usually recommended for people who are taking ritonavir.

The antifungal itraconazole should be used with caution in people using Flixotide. Long courses of treatment with this antifungal should be avoided where possible.

If you have any more questions please ask your Pharmacist.

Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.

References:

https://www.old.health.gov.il/units/pharmacy/trufot/alonim/Flixotide-Diskus-PT-ENG_1451542493373.pdf

https://www.drugs.com/international/flixotide-diskus.html

http://patient.info/medicine/fluticasone-inhaler-flixotide

http://www.rxlist.com/flovent-diskus-drug.htm

http://www.netdoctor.co.uk/medicines/allergy-and-asthma/a8286/flixotide-fluticasone/