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 Visser2004Angelini2013. 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 Angelini2013Smith2022. 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 Visser2004Harrison2001. However, at recommended or modest doses, FP does not significantly affect adrenal function or cause systemic side effects in children Angelini2013Smith2022. 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 Visser2004Angelini2013Griffiths2004+2 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 Visser2004Harrison2001Wang2017. Regular monitoring is advised for children on long-term or high-dose FP therapy.
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