Dosing and uses of Cutivate (fluticasone topical)
Adult dosage forms and strengths
cream
- 0.05%
ointment
- 0.005%
lotion
- 0.05%
Atopic Dermatitis
Cream/lotion: Apply qDay-q12hr; reassess diagnosis if no improvements within 2 weeks
Corticosteroid-responsive Dermatoses
Cream/lotion: Apply qDay or q12hr; reassess diagnosis if no improvements within 2 weeks
Pediatric dosage forms and strengths
cream
- 0.05%
lotion
- 0.05%
Atopic Dermatitis
Lotion
- <3 months: Safety & efficacy not established
- >3 months: As adults; apply cream/lotion sparingly qDay-q12hr
Lotion
- <1 year: Safety & efficacy not established
- >1 year: As adults; apply sparingly qDay
Corticosteroid-responsive Dermatoses
Cream
- <3 months: Safety & efficacy not established
- >3 months: Apply qDay or q12hr; reassess diagnosis if no improvements within 2 weeks
Cutivate (fluticasone topical) adverse (side) effects
1-10%
Pruritus (2.9%)
Dryness (1.2%)
Skin irritation: (3%)
Eczema (1%)
Telangiectasia (2-5%)
Numbness of fingers (1%)
<1%
Burning
Folliculitis
Acneiform lesions
Urticaria
Hypertrichosis
Lightheadedness
ViraL
Warts
Impetigo
Skin infection
Frequency not defined
Striae
Pigmentation changes
HPA suppression (with higher potency used >2 wk)
Erythema
Cushing syndrome
Sepsis
Hemorrhage reported
Edema/swelling
Warnings
Contraindications
Hypersensitivity
Underlying infection
Skin atrophy
Perioral dermatitis
Rosacea
Ophthalmic use
Cautions
Safety/efficacy in peds use longer than 4 wk not established
Ointment not indicated for atopic dermatitis
Use med to very high potency for <2 wk to reduce local and systemic side effects
Use low potency for chronic therapy
Reversible HPA axis suppression and resulting clinical glucocorticoid insufficiency can occur during or after withdrawal of treatment; risk factors include use over large surface area, prolonged use, use under occlusion, altered skin barrier, liver failure, and young age; children may exhibit greater susceptibility to corticosteroid-induced HPA axis suppression and Cushing's syndrome due to larger skin surface area to body weight ratio; modify use if HPA axis suppression is suspected;
Avoid medium to very high potency on face, folds, groin because can increase steroid absorption
Use lower potency for children (ie, increase BSA/kg, therefore increase systemic absorption)
Contains imidurea as excipient which releases formaldehyde as a breakdown product; may cause allergic sensitization or irritation upon contact
May cause irritation, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection, skin atrophy, striae, hypertrichosis, and miliaria; especially with high-potency or occlusive dressings
Pregnancy and lactation
Pregnancy category: C
Lactation: Excretion in milk unknown; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Cutivate (fluticasone topical)
Mechanism of action
Corticosteroids decrease inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes; inhibiting macrophage accumulation in inflamed areas; reducing leukocyte adhesion to capillary endothelium; reducing capillary wall permeability and edema formation; decreasing complement components; antagonizing histamine activity and release of kinin from substrates; reducing fibroblast proliferation, collagen deposition, and subsequent scar tissue formation
Pharmacokinetics
Absorption: 6% (animal studies; 5% systemic, 1% in skin)
