Flovent (fluticasone propionate) is a widely used inhaled corticosteroid (ICS) prescribed for managing asthma in patients aged four and older. It reduces inflammation in the airways, helping to prevent asthma attacks and improve breathing.
In late 2023, GSK, the company that produces several well-known inhaled steroids and inhalers, ceased the production of both Flovent HFA and Flovent Diskus. This unexpected discontinuation has left many of the 24.8 million Americans with asthma, including 6 million children, in need of reliable alternatives to support their respiratory health.
In this article, we’ll explore effective alternatives to Flovent, offering detailed insights into their benefits, usage, and why they might be considered viable options.
Top 8 Best Flovent Alternatives
Several medications can serve as alternatives to Flovent, each with its own set of benefits and considerations:
1. Arnuity Ellipta (fluticasone furoate)
Arnuity Ellipta is an effective inhaled corticosteroid for managing asthma. It is designed for adults and children aged five years and older. This inhaler contains a similar active ingredient to Flovent, but fluticasone furoate is generally considered more potent than fluticasone propionate.
One notable advantage of Arnuity Ellipta is its once-daily dose, making it a simpler and more manageable routine compared to Flovent. It’s especially useful for children or those with busy schedules. Arnuity Ellipta is available in 50 mcg, 100 mcg, and 200 mcg strengths, delivered through a dry powder Ellipta inhaler, which makes it an excellent alternative to Flovent Diskus.
Pros:
- Fewer side effects
- Alternative to Flovent Diskus
- Requires just one inhalation per day
- Effective in reducing and preventing asthma symptoms
- Helps decrease the frequency and severity of asthma attacks
Cons:
- Not suitable for individuals aged four years old
- Contains milk protein, which is a potential allergen
- Higher cost compared to Flovent
2. Pulmicort Flexhaler (budesonide)
Pulmicort Flexhaler is a corticosteroid inhaler used for asthma maintenance in patients six years and older. It comes in two strengths–90 mcg and 180 mcg per actuation. The starting dose for adults is 360 mcg twice daily, while for children, it’s 180 mcg twice daily.
The Flexhaler features an inhalation-driven multi-dose system that requires the patient to inhale deeply and forcefully to receive the medication. It’s a specific type of dry powder inhaler, but its physical design and user interface are different from those of Flovent Diskus. Pulmicort Flexhaler has a twist mechanism, while Flovent Diskus has a sliding lever.
In a study assessing the effects of budesonide and fluticasone propionate in pediatric asthma patients, lung function improved more quickly in the budesonide group. On the other hand, the fluticasone group exhibited superior anti-inflammatory responses. This indicates that each inhaled corticosteroid has distinct clinical and laboratory impacts.
Pros:
- Alternative to Flovent Diskus
- Effective for controlling asthma
- Comparable side effects of Flovent
- Similar dosing frequency to Flovent
- Cheaper alternative to Flovent Diskus (available for as low as $44 in Pharma Giant)
Cons:
- Not suitable for patients aged four years old
- Only available in two dosage strengths
- Contains milk protein, which is a potential allergen
3. QVAR RediHaler (beclomethasone dipropionate)
QVAR RediHaler, available as an inhalation aerosol, provides an excellent alternative to Flovent HFA. More importantly, the RediHaler is simpler to use as it’s breath-actuated, automatically releasing medication when the patient inhales. In contrast, Flovent HFA requires manual activation, where the patient must press the canister while inhaling simultaneously.
It is indicated for patients aged four years and older as a prophylactic therapy, ensuring consistent control of asthma symptoms. The device is breath-actuated and does not require shaking or priming, making it more convenient and user-friendly, especially for younger patients or those with difficulty handling.
For adults and adolescents aged 12 years and older, the typical starting dosage ranges from 40 mcg to 80 mcg, taken twice daily. Meanwhile, for children aged 4 to 11 years, the recommended starting dose is 40 mcg twice daily, which can be increased to 80 mcg twice daily if needed.
Results from a real-life observational study of the General Practice Research Database (GPRD) revealed that asthma patients treated with QVAR, either as initial therapy or with an increased (step-up) dose, had a similar or better chance of achieving asthma control compared to patients treated with Flovent.
Pros:
- Fewer side effects
- Alternative to Flovent HFA
- Easier to use than the Flovent HFA
- Does not require the need for shaking or priming
- Caters to pediatric patients aged four years old
- Cheaper alternative to Flovent HFA (available for as low as $60 for 200 doses)
Cons:
- Only available in two dosage strengths
4. Asmanex Twisthaler/HFA (mometasone furoate)
Asmanex is available in two forms–the Twisthaler (dry powder) and the HFA inhaler. Both are used for the maintenance treatment of asthma but offer distinct features that may appeal to different patient needs. Both forms contain mometasone furoate, a corticosteroid that reduces inflammation in the airways, helping to prevent asthma symptoms.
The Asmanex Twisthaler is activated by twisting the cap, offering a simpler approach than Flovent Diskus. It is indicated for patients aged four years and older and delivers 110 mcg or 220 mcg of mometasone furoate per actuation. The Twisthaler’s typical starting dose is 220 mcg once daily or 220 mcg twice daily for more severe cases. The highest recommended daily dose for adults is 880 mcg.
On the other hand, Asmanex HFA, a metered-dose inhaler, is designed for patients aged 12 years and older. It is available in strengths of 100 mcg or 200 mcg per actuation. The recommended dosage for Asmanex HFA is typically two inhalations twice daily.
A 2004 study found that the mometasone furoate dry powder inhaler offered similar efficacy to fluticasone propionate HFA in patients with moderate persistent asthma previously treated with fluticasone propionate.
Pros:
- Has a generic equivalent
- Fewer side effects in both forms
- Alternative to Flovent HFA and Diskus
- The Twisthaler is easier to use than the Diskus
Cons:
- Higher price point (60 doses of 110 mcg Asmanex Twisthaler costs $145)
- The HFA inhaler is not indicated for patients aged 4-11 years old
- Only available in two dosage strengths, requiring multiple inhalations
5. Alvesco (ciclesonide)
Alvesco is an inhaled corticosteroid for controlling asthma in adults and children aged 12 and older. It is an alternative to Flovent HFA, available in 80 and 160 mcg strengths. Similar to Flovent HFA, it should be primed before the first use or if unused for over ten days.
Patients starting from bronchodilators alone typically use 80 mcg twice daily, which can go up to 160 mcg twice daily. Those switching from other inhaled corticosteroids start with 80 mcg twice daily, potentially increasing to 320 mcg twice daily.
A 2006 study found that ciclesonide 160 mcg once daily was equally effective as fluticasone propionate 88 mcg twice daily in enhancing lung function, alleviating asthma symptoms, and reducing the need for rescue medication in asthma patients.
Pros:
- Alternative to Flovent HFA
- On par with Flovent in terms of improving lung function and alleviating asthma symptoms
Cons:
- Not suitable for patients younger than 12 years old
- Has more side effects, including pain in the extremities and back pain
- More expensive (120 doses of 80 mcg Alvesco costs $79)
6. Advair Diskus/HFA (fluticasone propionate/salmeterol)
Advair Diskus and Advair HFA are medications used to manage asthma and chronic obstructive pulmonary disease (COPD). They combine fluticasone propionate, an inhaled corticosteroid similar to Flovent, and salmeterol, a long-acting beta2-adrenergic agonist (LABA). This combination provides anti-inflammatory and bronchodilator effects.
Advair Diskus is approved in patients aged four years and older. This inhaler has three strengths–100/50 mcg, 250/50 mcg, and 500/50 mcg. The usual dosage is one inhalation twice daily, about 12 hours apart. Meanwhile, Advair HFA is approved in patients aged 12 years and older. The recommended dosage is two inhalations twice daily, about 12 hours apart. Like the Diskus, the HFA form comes in three strengths–45/21 mcg, 115/21 mcg, and 230/21 mcg per actuation.
Advair Diskus/HFA offers a combined therapy of corticosteroid and LABA, unlike Flovent, which contains only fluticasone propionate. This makes Advair a better option for patients needing both anti-inflammatory and bronchodilator effects. Flovent is effective for reducing inflammation and controlling asthma symptoms but does not provide the bronchodilator benefits.
Pros:
- Alternative for Flovent inhalers
- Suitable for patients with COPD
- Comparable side effects of Flovent
- Generic alternatives are available for both forms
- Provides both anti-inflammatory and bronchodilator effects
Cons:
- Higher risk of pneumonia in COPD patients
- Do not use with other LABA medicines to avoid overdose
- Not suitable for patients younger than 12 years old
- Caution in patients with convulsive disorders, thyroid issues, diabetes, and ketoacidosis
- Higher price point (the price of Advair HFA ranges from $125-$375, while the Diskus ranges from $149-$630)
Did you know…
In 2023, drugmaker GlaxoSmithKline announced a significant reduction in the US list prices of the asthma medication Advair by up to 70%.
If Advair is still costly in your area, you can save up to 90% by purchasing it from Pharma Giant. Additionally, our website offers various alternatives to Advair that provide effective relief for asthma and COPD.
7. Breo Ellipta (fluticasone furoate/vilanterol)
Breo Ellipta, combining fluticasone furoate and vilanterol, is used for the maintenance treatment of COPD and asthma in patients aged five years and older. It comes in three dosage strengths–50/25 mcg, 100/25 mcg, and 200/25 mcg. Each actuation provides a measured dose of fluticasone furoate and vilanterol, designed for once-daily use.
For COPD patients, the recommended dose of Breo Ellipta is 100/25 mcg once daily. Asthma patients may require different doses based on age and severity, with a possible increase to 200/25 mcg for better control.
Breo Ellipta is a practical alternative to Flovent Diskus. Its once-daily dosing and combination of ICS and LABA offer convenience and effective treatment for COPD and asthma.
Pros:
- Alternative for Flovent Diskus
- Suitable for patients with COPD
- More side effects, including hypertension and pyrexia
- Provides both anti-inflammatory and bronchodilator effects
- The Ellipta inhaler is generally easier to use compared to the Diskus inhaler
Cons:
- Not suitable for patients aged four years old
- Higher risk of pneumonia in COPD patients
- Do not use with other LABA medicines to avoid overdose
- Caution in patients with convulsive disorders, thyroid issues, diabetes, and ketoacidosis
- More expensive than Flovent, with prices starting from $150
8. Symbicort (budesonide/formoterol)
Symbicort Turbuhaler is an effective treatment for asthma and COPD, combining budesonide with formoterol. Formoterol, like salmeterol and vilanterol, is a LABA that achieves bronchodilation by relaxing airway smooth muscle.
Symbicort is available in doses of 80/4.5 mcg and 160/4.5 mcg per inhalation and is administered via a metered-dose inhaler, making it a suitable alternative to Flovent HFA. One advantage of Symbicort is that it is approved for both asthma and COPD, while Flovent HFA is only approved for the treatment of asthma.
A study found that Symbicort reduced the risk of hospitalizations and emergency room visits by 28%. When used as maintenance and reliever therapy (320/9 mcg per day), it further reduced the risk by 37%.
Pros:
- Alternative for Flovent HFA
- Suitable for patients with COPD
- Has more side effects, including stomach discomfort and back pain
- Provides both anti-inflammatory and bronchodilator effects
Cons:
- Higher risk of pneumonia in COPD patients
- Risk of overdose when used with other medicines containing LABA
- Treatment of asthma is not suitable for patients younger than six years old
- Caution in patients with convulsive disorders, thyroid issues, diabetes, and ketoacidosis
- More expensive than Flovent with prices starting from $145
Generic Alternatives to Flovent
In a significant development for asthma patients, an authorized generic version of Flovent has been released, potentially reducing costs by 50%. This new generic option provides an affordable alternative for those reliant on Flovent for their respiratory health. The authorized generic versions have already been introduced in 2022 and 2023 and offer the same efficacy and safety profile as the brand-name Flovent.
Natural Alternative to Flovent
While these options are not substitutes for Flovent, they can aid in managing asthma and other respiratory illnesses. Natural remedies and lifestyle changes offer holistic approaches to improving lung health and overall well-being. The most studied natural alternatives are:
Herbal Remedies
Butterbur (Petasites hybridus)
Butterbur’s active compounds, particularly petasins, have been shown to inhibit leukotriene and histamine activities, which are involved in inflammatory responses in asthma and bronchitis. A study found that butterbur extract could reduce airway hyper-responsiveness and inflammation in mice, suggesting potential benefits for asthma management in humans. However, clinical studies on humans have shown mixed results.
One double-blind study found significant improvement in airflow among asthma patients using butterbur extract compared to a placebo, but there were also indications of increased asthma attack frequency in some cases.
One of the main concerns with butterbur is the presence of pyrrolizidine alkaloids (PAs), which can cause liver toxicity. To avoid these risks, it is crucial to use PA-free butterbur extracts.
Boswellia (Boswellia serrata)
Studies suggest that Boswellia serrata, also known as Indian frankincense, may be effective in treating asthma and other respiratory illnesses. Boswellia serrata contains active compounds called boswellic acids, which have anti-inflammatory properties.
A clinical trial published in the European Journal of Medical Research (1998) investigated the effects of Boswellia serrata in patients with bronchial asthma. The study involved 40 patients who were given 300 mg of Boswellia serrata extract three times daily for 6 weeks. The results showed significant improvement in symptoms, including decreased frequency of asthma attacks, improved lung function, and reduced blood eosinophil counts compared to the placebo group.
Dietary Supplements
Omega-3 Fatty Acids
Omega-3 fatty acids, commonly found in fish oil, have been studied for their potential benefits in managing asthma and other respiratory illnesses. A study from Johns Hopkins Medicine found that higher dietary intake of omega-3 fatty acids is associated with fewer asthma symptoms in children exposed to indoor air pollution.
In addition, a 2020 study investigated the levels of omega-3 polyunsaturated fatty acids (n-3 PUFA) in the blood (specifically in erythrocyte membranes) and their impact on asthma control. The findings suggest that higher levels of omega-3 fatty acids in the blood are associated with better asthma control and lower doses of inhaled corticosteroids, implying that omega-3 supplements could potentially play a role in managing asthma.
Vitamin D
Vitamin D has shown potential benefits in managing asthma and other respiratory conditions, primarily due to its immune-modulating and anti-inflammatory properties. However, research has shown mixed results, with some studies indicating a potential benefit in reducing exacerbations and others showing no significant effect.
One study demonstrated that vitamin D supplementation led to a 30% reduction in asthma exacerbations among patients with mild to moderate asthma and low vitamin D levels. However, a recent review in the Cochrane Database of Systematic Reviews indicated that vitamin D intake is unlikely to improve asthma symptoms or decrease the risk of asthma attacks.
Lifestyle Changes
Breathing Exercises
Practicing breathing exercises can greatly help in managing asthma and various respiratory ailments. Here are several ways in which breathing exercises can help:
- Improving lung function: Breathing exercises can strengthen the respiratory muscles, increase lung capacity, and enhance the respiratory system’s efficiency. Techniques such as diaphragmatic breathing, where one breathes deeply into the diaphragm rather than shallowly into the chest, can help improve lung function over time.
- Reducing symptoms: Respiratory conditions often cause symptoms like shortness of breath, wheezing, and coughing. Breathing exercises can help reduce these symptoms by promoting better airflow and reducing airway resistance. Techniques like pursed-lip breathing, where one inhales through the nose and exhales slowly through pursed lips, can help keep the airways open longer and reduce breathlessness.
- Enhancing relaxation: Breathing exercises can activate the parasympathetic nervous system, which promotes relaxation and reduces stress and anxiety. Since stress can exacerbate respiratory conditions, practicing breathing exercises can help manage stress levels and prevent symptom flare-ups.
- Improving airway clearance: Certain breathing techniques, such as the Huff Cough, can help clear mucus from the airways, making it easier to breathe. This is particularly useful for conditions like COPD, where mucus buildup is a common problem.
- Enhancing overall respiratory efficiency: Breathing exercises can help improve the efficiency of the respiratory system by optimizing the oxygen and carbon dioxide exchange. This can result in better oxygenation of the blood and tissues, which is crucial for overall health and well-being.
- Building awareness and control: Regular practice of breathing exercises helps individuals become more aware of their breathing patterns and learn how to control their breath during episodes of breathlessness or asthma attacks. Techniques like the Buteyko Method focus on nasal breathing and breath-holding exercises to help manage asthma symptoms.
More importantly, breathing exercises can complement other treatments for respiratory conditions, such as medication and physical therapy. Integrating breathing exercises into a comprehensive treatment plan can enhance overall effectiveness and improve outcomes.
Regular Physical Activity
Exercise can enhance lung function by increasing lung capacity and strengthening respiratory muscles. This helps individuals breathe more easily and effectively. Other benefits of regular physical activity include:
- Better asthma control: Engaging in regular physical activity can lead to fewer asthma symptoms and attacks. Exercise helps improve the efficiency of oxygen utilization in the body, reducing the frequency and severity of asthma flare-ups.
- Enhanced immune function: Regular exercise boosts the immune system, making it more effective at fighting infections that can exacerbate respiratory conditions.
- Reduced inflammation: Physical activity has anti-inflammatory effects, which can help reduce the chronic inflammation associated with asthma and other respiratory conditions.
- Weight management: Maintaining a healthy weight through regular exercise can lessen the strain on the respiratory system. Obesity can worsen asthma symptoms, so weight management is crucial.
- Improved cardiovascular health: Exercise improves cardiovascular fitness, which enhances the efficiency of the heart and lungs. Better cardiovascular health can reduce the workload on the respiratory system.
- Stress reduction: Exercise is a great way to manage stress, which can be a trigger for asthma symptoms. Lower stress levels can lead to fewer asthma exacerbations.
- Increased physical endurance: Regular physical activity can increase stamina and endurance, making it easier for individuals with respiratory conditions to engage in daily activities without experiencing shortness of breath.
Regular exercise can improve the quality of life for individuals with asthma or other respiratory conditions by enhancing physical health, reducing symptoms, and increasing energy levels.
Making the Transition
When switching from Flovent to an alternative, it is crucial to follow a healthcare provider’s guidance. Here are some general steps to consider:
1. Consult Your Healthcare Provider
Schedule an appointment with your healthcare provider to discuss your intention to switch. Your doctor can help identify the most suitable alternative based on your medical history, current condition, and specific needs.
2. Understand Your Options
Familiarize yourself with potential alternatives for Flovent. Understand the differences in ingredients, dosage, administration, and efficacy, and consider the potential side effects of the alternative medications and how they compare to those of Flovent.
3. Get a Prescription
Your doctor will prescribe the new medication and provide instructions on dosage and administration. Check with your insurance provider to see if the new medication is covered and understand the cost implications.
4. Transition Plan
Adhere to the transition plan provided by your doctor. This may involve gradually tapering off Flovent while starting the new medication. Keep track of your symptoms during the transition period. Report any adverse effects or concerns to your healthcare provider immediately.
5. Education and Training
Ensure you understand how to use the new inhaler or medication device correctly. Ask for a demonstration from your healthcare provider or pharmacist if needed. Make any necessary lifestyle adjustments to support your respiratory health, such as avoiding triggers, maintaining a healthy diet, and following an exercise plan.
6. Follow-Up Appointments
Schedule follow-up appointments to monitor your progress and make any necessary adjustments to your treatment plan. Assess the effectiveness of the new medication and discuss any concerns or side effects with your doctor.
Switching from Flovent to an alternative requires careful consideration and collaboration with a healthcare provider to ensure a smooth and effective transition.
Takeaway
Choosing the right alternative to Flovent depends on various factors, including individual response to medication, ease of use, and cost considerations. Each of the alternatives discussed above offers unique benefits, making them viable options for patients seeking effective management of asthma. Consulting with a healthcare provider is essential to determine the most suitable treatment based on individual needs and medical history.
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