Fluticasone propionate long term side effects
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Fluticasone Propionate Long-Term Side Effects: Safety and Risks
Growth and Development in Children
Long-term use of high doses of fluticasone propionate (FP) in children with asthma has been linked to reduced growth velocity and impaired adrenal cortical function. Studies show that doses of 1,000 and 500 µg/day are associated with marked reductions in growth rate, bone turnover, and adrenal function, while conventional doses (≤200 µg/day) appear to be safe for long-term management and do not significantly affect growth or bone health 12. Another study found that after one year of treatment, children using FP had lower increases in weight and height compared to healthy controls, suggesting that long-term use may impact normal growth and development and should be used with caution .
Bone Metabolism and Bone Mineral Density
Research indicates that high doses of FP (≥1,000 µg/day) do not significantly reduce bone metabolism or bone mineral density when bone age is taken into account. However, some children on long-term FP therapy showed lumbar spine density more than one standard deviation below the mean, though this was not statistically significant after correcting for bone age . Other studies confirm that standard doses of FP do not alter bone metabolism or bone mass density in children 25. In contrast, long-term use (over 6–12 months) may lead to reduced bone mineral density and changes in bone metabolism markers, especially at higher doses or with combination therapy, which could affect growth and development .
Adrenal Function and Systemic Effects
High doses of FP can suppress adrenal cortical function, as shown by reduced serum cortisol levels and other markers of hypothalamic-pituitary-adrenal (HPA) axis activity 16. However, at recommended or modest doses, FP does not significantly affect adrenal function or cause systemic side effects in children 25. Compared to other inhaled corticosteroids like beclomethasone, FP at standard doses has a lower risk of systemic effects on the HPA axis and growth .
Ocular Safety
Long-term, intermittent use of FP at average daily doses around 320 µg in children does not appear to cause ocular side effects such as cataract formation, corneal ectasia, ocular hypertension, glaucoma, or dry eye. No correlation was found between total steroid dosage and eye function changes, suggesting that recommended doses are safe for ocular health in children .
Summary and Conclusion
In summary, long-term use of fluticasone propionate at standard, recommended doses (≤200–250 µg/day) in children with asthma is generally safe and does not cause significant systemic side effects, including effects on growth, bone health, adrenal function, or ocular health 1234+1 MORE. However, higher doses or prolonged use may increase the risk of reduced growth velocity, bone mineral density, and adrenal suppression, so such regimens should be reserved for severe cases and used with caution 167. Regular monitoring is advised for children on long-term or high-dose FP therapy.
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Most relevant research papers on this topic
Side-effects of fluticasone in asthmatic children: no effects after dose reduction
High doses of fluticasone propionate (1,000 and 500 g/day) in asthmatic children can reduce growth velocity, bone turnover, and adrenal cortical function, but conventional doses (200 g/day) are safe for long-term management.
Effect of high‐dose fluticasone propionate on bone density and metabolism in children with asthma
High-dose inhaled fluticasone propionate does not significantly reduce bone metabolism or bone age-corrected bone mineral density in children with asthma.
Evaluation impact of long-term usage of inhaled fluticasone propionate on ocular functions in children with asthma.
Long-term intermittent use of inhaled fluticasone propionate spray, as much as 320 g daily, in children with asthma appears to be safe for some eye functions.
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Beclomethasone dipropionate has significant effects on the hypothalamic-pituitary-adrenal axis and statural growth in childhood asthma patients, while fluticasone propionate shows no such systemic effects.
Comparison of the systemic effects of fluticasone propionate and budesonide given by dry powder inhaler in healthy and asthmatic subjects
Fluticasone propionate has a greater effect on the hypothalamic-pituitary-adrenal axis in healthy subjects than in asthmatic subjects, while budesonide has a similar effect in both groups.
Effect of long-term inhalation of salmeterol and fluticasone propionate in the treatment of children with bronchial asthma and the effect on bone metabolism and body mass
Long-term inhalation of salmeterol and fluticasone propionate in children with bronchial asthma may lead to reduced bone mineral density, affecting normal growth and development.
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