Flutiform

Flutiform is a combination inhaler that contains the inhaled corticosteroid fluticasone propionate and the long-acting beta-2 agonist formoterol. It combines the efficacy of fluticasone with the rapid onset of action of formoterol.

Flutiform is available as a conventional metered-dose inhaler and as the breath-actuated K-haler. The K-haler is triggered automatically on inhalation and is particularly suitable for patients who have difficulty with coordination.

Unlike Seretide, Flutiform contains formoterol instead of salmeterol.

Flutiform combines two active ingredients:

Fluticasone propionate (ICS):

• Potent inhaled corticosteroid
• Strong anti-inflammatory effect
• Low systemic bioavailability

Formoterol (LABA):

• Rapid onset of action (1-3 minutes)
• Long-lasting bronchodilation (12 hours)
• Full agonist at the beta-2 receptor
• Flutiform should not be used to treat acute asthma symptoms

Synergistic effect: Fluticasone increases beta-2 receptor density, and formoterol enhances the anti-inflammatory effect of the corticosteroid – each benefits from the other.

Flutiform is suitable for:

• Asthma in adults and adolescents aged 12 years and older
• When an ICS alone does not provide adequate control
• Patients who have difficulty using dry powder inhalers

Advantages:

• Fast-acting LABA (formoterol)
• Potent ICS (fluticasone)
• Breath-actuated K-haler version
• Various strengths available

Not suitable:

• As the sole emergency medication
• For children under 12 years of age, except the 50/5 µg strength from 5 years of age

Flutiform metered-dose inhaler / K-haler:

• 50/5 µg (fluticasone/formoterol) per puff
• 125/5 µg per puff
• 250/10 µg per puff (adults only)

Dosage:

• 2 puffs 2 times daily
• Strength depending on the severity of the asthma

Maximum:

• 4 puffs of the highest strength per day (1000/40 µg)

Metered-dose inhaler: 1. Remove the protective cap, shake the inhaler 2. Breathe out deeply 3. Close your lips around the mouthpiece 4. Breathe in slowly and deeply while releasing a puff 5. Hold your breath for 10 seconds 6. Rinse your mouth and spit out

K-haler (breath-actuated): 1. Open the protective cap 2. Hold the device upright 3. Breathe out deeply 4. Close your lips around the mouthpiece 5. Breathe in normally – it is triggered automatically 6. Hold your breath 7. Rinse your mouth

Important:

• 2 times daily, morning and evening
• Use regularly
• Rinse your mouth after inhalation

Do not use in case of:

• Hypersensitivity to fluticasone, formoterol or any of the ingredients

Use with caution in:

• Severe cardiovascular disease
• QT prolongation
• Overactive thyroid
• Diabetes mellitus
• Hypokalemia
• Pulmonary tuberculosis
• Treatment with CYP3A4 inhibitors (ritonavir!)

Pregnancy: Only if clearly indicated.

Breastfeeding: Benefit-risk assessment.

Uncommon:

• Hoarseness
• Headache
• Tremor
• Palpitations

Rare:

• Oral thrush
• Muscle cramps
• Restlessness
• Cough
• Systemic corticosteroid effects
• Paradoxical bronchospasm
• Cardiac arrhythmias

Prevention: Rinse your mouth after every inhalation!

Interactions:

• Ritonavir, cobicistat – greatly increased fluticasone levels (avoid!)
• Beta-blockers – can cancel out the effect of formoterol
• QT-prolonging medications
• CYP3A4 inhibitors (ketoconazole)

Not recommended:

• Other LABAs at the same time
• Non-selective beta-blockers in asthma