Eosinophilic Esophagitis Treatment – Swallowed Inhaled Fluticasone

Swallowed Fluticasone (Flovent) Therapy: How this medication is taken

No medication is currently FDA approved for treatment of eosinophilic esophagitis. Therefore any drug therapy options should be carefully considered by you and your treating physician.

Fluticasone propionate (Flovent) is an steroid medication that has been used to treat asthma. In recent years, it has also been used as an effective therapy to treat the eosinophilic inflammation in EE.

Fluticasone comes in two types of delivery devices:
– Metered dose inhalers (MDI) which are the puffers that are manually pumped to dispense the aerosolized steroid
– Diskus which deliver steroids when a patient breathes in from these round flat devices
The MDI, not the diskus, should be used to treat EE since the diskus is designed to promote steroid delivery to the lungs and not the esophagus.

This medication should only be taken under the supervision of a physician. If using this medication you need to consult with your doctor regarding appropriate dosages. Fluticasone MDI come in varying doses: 44 mcg, 110 mcg, and 220 mcg strengths. Typical doses range from 220 mcg to 440 mcg taken two times per day.

When using this medication, the MDI should be put into the mouth and puffed directly into the mouth without breathing in (to minimize delivery to the lungs). Then it should be dry swallowed. No food or drinks should be taken for 30 minutes afterwards to prevent the steroid from washing off the esophagus. You can rinse and spit, or brush your teeth afterwards to minimize steroid deposition within the mouth.

Reported side effects include:
– Yeast infection (Candida) within the esophagus
– Dry mouth
– A single case report of herpes infection of the esophagus with fluticasone therapy
If you are experiencing any unusual symptoms including increasing throat pain or pain with swallowing, you should contact your treating provider.

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