Re: Fluticasone vs Flunisolide

[Guest guest]

Hello Ken -

I've found some of the recent scientific discussion a little over my

head. Could you please clarify this recent discovery? Which drug should

you be taking, and why? Which shouldn't you be taking? Thanks,

Mona

At 07:30 PM 2004/02/05, you wrote:

I must re-thank ine for her

recent contribution re Fluticasone.

It got me curious, since I've been prescribed Nalcrom in Flunisolide

for

several years, with mixed results.

I googled with the two words, and sure enough, the first hit was:

http://www.findarticles.com/cf_dls/m0984/4_118/71127825/p1/article.jhtml

which specifically states that the former is superior to

thelatter.

Off to my allergist asap! Why isn't he reading the

internet!?!?!?!

Thanks again ine -- another great internet moment!

regards,

Ken West

From: pauline newnham <pauline_newnham@...>

Reply-samters

Date: Thu, 5 Feb 2004 14:06:18 -0800 (PST)

samters

Subject: Benzalkonium chloride

.. . . snip . . .

Also see Paper titled Fluticasone propionate in the files section (I

am

hoping Ken will put it there for me) which recommends fluticasone

propionate

as a better alternative (please note that this is available in uk but

maybe

not America you would need to check). It is not as

systemically absorbed

.. . . snip . . .

[Guest guest]

Ken, the article to which you pointed says "greater HPA axis suppression occurs with inhaled fluticasone propionate than with flunisolide." This should not be counted as a plus for fluticasone -- you do probably do NOT want HPA axis suppression -- that is, you do want the effects of the inhaled steroid to peripheral, not systemic. Put another way, you don't want to have the same sorts of side effects you get from taking prednisone. On the other hand, one could argue that these results simply reflect the fact that fluticasone is the more powerful drug, and we have heard that here before.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Karl L. Wuensch, Department of Psychology,East Carolina University, Greenville NC 27858-4353Voice: 252-328-4102 Fax: 252-328-6283WuenschK@...http://core.ecu.edu/psyc/wuenschk/klw.htm

Fluticasone vs Flunisolide

I must re-thank ine for her recent contribution re Fluticasone.It got me curious, since I've been prescribed Nalcrom in Flunisolide forseveral years, with mixed results.I googled with the two words, and sure enough, the first hit was:http://www.findarticles.com/cf_dls/m0984/4_118/71127825/p1/article.jhtmlwhich specifically states that the former is superior to thelatter.Off to my allergist asap! Why isn't he reading the internet!?!?!?!Thanks again ine -- another great internet moment!regards,Ken West From: pauline newnham <pauline_newnham@...>Reply-samters Date: Thu, 5 Feb 2004 14:06:18 -0800 (PST)samters Subject: Benzalkonium chloride. . . snip . . .Also see Paper titled Fluticasone propionate in the files section (I amhoping Ken will put it there for me) which recommends fluticasone propionateas a better alternative (please note that this is available in uk but maybenot America you would need to check). It is not as systemically absorbed. . . snip . . .

[Guest guest]

Hi Ken,

Bob McGinnis (http://www.aafp.org/afp/971001ap/letters.html), who used to post here but then suddenly stopped doing so, provided a URL to a report that compared the steroids commonly used for inhalation and intranasally, and fluticasone was the most potent. That motivated me to use Flonase, after the "puffer" delivery mechanisms were discontinued.

Karl W.

Re: Fluticasone vs Flunisolide> Ken, the article to which you pointed says "greater HPA axis suppression> occurs with inhaled fluticasone propionate than with flunisolide." This> should not be counted as a plus for fluticasone -- you do probably do NOT want> HPA axis suppression -- that is, you do want the effects of the inhaled> steroid to peripheral, not systemic. Put another way, you don't want to have> the same sorts of side effects you get from taking prednisone. On the other> hand, one could argue that these results simply reflect the fact that> fluticasone is the more powerful drug, and we have heard that here before.Thanks Karl.I admit to doing a lot of skimming of this recent stuff, for now, but I'msaving it to analyze in more detail, as soon as I get a round tuit.Having said that, I just did a search on "fluticasone" in the archives, andit just came up with the 7 posts that were done today. Not sure where Ihave heard that before, as you suggest.Ken West> > > Karl L. Wuensch, Department of Psychology,> East Carolina University, Greenville NC 27858-4353> Voice: 252-328-4102 Fax: 252-328-6283> WuenschK@...> http://core.ecu.edu/psyc/wuenschk/klw.htm>

[Guest guest]

It is not I who is saying that inhaled fluticasone has a greater systemic effect than do the comparison products, it is the authors of the study posted by Ken, T B Casale, H S , W Stricker, J A Fourre, K B Newman. I quote:

Suppression of the hypothalamic-pituitary-adrenal (HPA) axis is a marker of systemic absorption of corticosteroids.

.....greater HPA axis suppression occurs with inhaled fluticasone propionate than with flunisolide. Furthermore, the pattern of suppression was different between the 2 drugs, with fluticasone propionate causing cortisol suppression throughout the entire day.

Now, is this of any consequence to the person who is using fluticasone nasal spray (not inhaling the product designed to treat asthma)? Probably not, at least for most persons. I certainly am not going to worry about it.

Karl W.

-----Original Message-----From: pauline newnham [mailto:pauline_newnham@...] Sent: Friday, February 06, 2004 7:03 AMsamters Subject: Re: Fluticasone vs Flunisolide

Karl,

I don't know what you mean by the most potent, but could it be that it has the most effectiveness without the systemic effects? Glennis Scadding reports that "The low systemic availability explains the lack of significant effect on cortisol levels."

ine "Karl L. Wuensch" <WuenschK@...> wrote: