Flovent vs Albuterol

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to difficulty breathing, wheezing, chest tightness, and coughing. This condition affects over 27 million Americans and is the leading chronic disease in children. Every day, ten lives are lost to asthma in the US, highlighting its seriousness.

Amidst these challenges, knowledge and proactive care become crucial. In this article, we’ll discuss two popular asthma medications, Flovent and Albuterol, aiming to provide insight into their differences in usage, dosage, and cost.

Key Differences Between Flovent and Albuterol

Parameters	Flovent (fluticasone)	Albuterol
Cost	$255 to $590	$70 to $100
Prescription Requirement	Prescription-only	Prescription-only
Generic Availability	Available	Available
Drug Class	Inhaled corticosteroids	Beta2-adrenergic agonist bronchodilators
Usage	Maintenance medication	Rescue medication
Forms	Inhalation aerosol and inhalation powder	Inhalation aerosol, nebulizer solution, inhalation powder, immediate-release tablet, extended-release tablet, or oral syrup
Route of Administration	Inhaled	Inhaled or oral
Dosage	Twice daily	As needed until symptoms improve under the supervision of a doctor.
Indications	Maintenance treatment of asthma.	Used to treat or prevent bronchospasm.
Side effects	Coughing, sore throat, hoarseness, upper respiratory infections, headache, and sinus infection or swelling.	Headaches, shakiness, fast or irregular heart rate, vomiting, chest pain, nausea, sore throat, runny nose, and dizziness.
Duration of Action	Long-acting drug	Short-acting drug

Approved Indications

What is Flovent used for?

Flovent is the brand name for a medication with the generic name fluticasone propionate, available only through a prescription. It falls under the category of inhaled corticosteroids (ICS) and is recommended for the ongoing management of asthma as a preventive measure in individuals aged four years and above.

What is Albuterol used for?

Albuterol, also known as salbutamol, is a prescription medication approved by the US Food and Drug Administration (FDA) for the treatment and prevention of acute or severe bronchospasm in patients with reversible obstructive airway disease, including exercise-induced bronchospasm.

In managing asthma symptoms, albuterol may be utilized as part of a combination therapy with inhaled corticosteroids, long-acting beta-agonists, and bronchodilators.

Mechanism of Action

How does Flovent work?

The exact way in which fluticasone propionate (the active ingredient in Flovent) works in treating asthma isn’t fully understood. However, it’s known to have anti-inflammatory effects.

Asthma involves inflammation in the airways, which contributes to symptoms like wheezing and shortness of breath. Corticosteroids like fluticasone propionate are effective because they can target and inhibit various types of cells involved in the inflammatory response, such as mast cells, eosinophils, and lymphocytes.

Additionally, they can reduce the production or release of substances like histamine and leukotrienes, which are involved in the allergic and inflammatory reactions characteristic of asthma. By reducing inflammation in the airways, corticosteroids like Flovent can help control asthma symptoms and prevent asthma attacks.

How does Albuterol work?

What albuterol does is it targets specific receptors in the body known as beta 2-adrenergic receptors. These receptors are found in the lungs, particularly in the muscles surrounding the airways. When albuterol binds to these receptors, it causes these muscles to relax, which opens up the airways and makes breathing easier.

Additionally, albuterol helps to prevent the release of certain substances, like histamine, from cells called mast cells. These substances can trigger allergic reactions or exacerbate symptoms of asthma.

Dosage Forms and Administration

How to use Flovent?

Flovent comes in two forms, Flovent HFA and Flovent Diskus, both used for asthma. Flovent HFA is an inhalation aerosol that uses a propellant or mechanism in the inhaler to facilitate the distribution of medication into the lungs. The abbreviation “HFA” denotes hydrofluoroalkane, a propellant known for being environmentally friendly.

In contrast, Flovent Diskus operates as a powder inhaler and does not use a propellant. Instead, it relies on the individual’s inhalation capacity to effectively disperse the powder medication.

To properly use Flovent HFA inhaler:

• Before the first use or if it hasn’t been used for 7 days or more, prime the inhaler by spraying it into the air four times away from your face. If it hasn’t been used for 7 days, spray it once into the air.
• Shake the inhaler for 5 seconds before each use.
• Remove the cap and check for foreign objects. Ensure the canister is fully inserted.
• Exhale fully, then place the mouthpiece in your mouth, closing your lips around it.
• Depress the canister while inhaling deeply and slowly through your mouth. Remove the inhaler and hold your breath for 10 seconds.
• If more than one puff is needed, wait 30 seconds between doses.
• Rinse your mouth with water after use and replace the cap.
• Clean the mouthpiece weekly with a cotton swab and water, letting it air dry overnight.
• Monitor the dose counter; when it reaches “020”, contact your doctor or pharmacist for a refill.

To properly use Flovent Diskus inhaler:

• Remove the inhaler from its pouch.
• Open it by pushing the thumb grip away until it clicks and appears open.
• Slide the mouthpiece lever away until it clicks; do not close or move the lever.
• Exhale, then inhale deeply through the mouthpiece.
• Hold your breath for 10 seconds, then exhale slowly.
• If more than one inhalation is prescribed, repeat the steps.
• Close the inhaler by sliding the thumb grip back until it clicks shut.
• Rinse your mouth after use and do not swallow the water.
• Monitor the dose window; when it shows 5 doses remaining, refill your prescription.

The dosage of both Flovent HFA and Diskus is determined by the patient’s past asthma treatment, the severity of asthma, and an assessment of their current management of asthma symptoms and the likelihood of future worsening.

Here are the dosage schedules for Flovent HFA and Flovent Diskus:

Flovent HFA

Patients experiencing poorer asthma control may also be prescribed starting dosages exceeding 88 mcg twice daily.

If a patient is currently undergoing chronic oral corticosteroid therapy, the dosage of prednisone should be reduced gradually, decreasing by 2.5 to 5 mg/day weekly, starting after at least one week of Flovent HFA therapy. Following the completion of prednisone reduction, the Flovent HFA dosage should be decreased to the lowest effective level.

Flovent Diskus

Patients may notice symptom relief at different times after starting treatment with Flovent HFA and Flovent Diskus. It could take 1 to 2 weeks or even longer to get the full benefits.

How to use Albuterol?

Albuterol comes in various dosage forms, including inhalation solutions, inhalation aerosols, inhalation powders, immediate-release tablets, extended-release tablets, and oral syrup. Common US brand names of albuterol include:

• Accuneb
• Ventolin
• Ventolin HFA
• Ventolin Diskus
• ProAir Digihaler
• ProAir HFA
• Proair Respiclick
• Proventil
• Proventil HFA
• Proventil Repetabs
• ReliOn Ventolin HFA
• Volmax
• VoSpire ER

Here’s a summary of the proper use for each form:

Inhalation Solution:

• Used with a jet nebulizer connected to an air compressor.
• Follow patient instructions carefully.
• Use one container of solution per dose.
• Breathe in the medicine through a face mask or mouthpiece for about 5 to 15 minutes.
• Clean all nebulizer parts after each use.

Inhalation Aerosol (HFA inhaler):

• Comes with a special inhaler.
• Insert the canister into the actuator.
• Shake the inhaler and test spray it before first use or if not used for more than 2 weeks.
• Breathe out fully, then inhale the medicine while pressing down on the canister.
• Hold your breath for 10 seconds, then breathe out slowly.
• Rinse mouth with water after use and clean the inhaler regularly.

Inhalation Powder (Diskus inhaler):

• Comes in a special inhaler.
• Take the inhaler from foil pouch before first use.
• Breathe out fully, then inhale deeply through the mouthpiece.
• Hold your breath for 10 seconds.
• Check the dose counter after each use.
• Close the cap firmly after each use.

Oral Tablets:

• Swallow whole with water or liquids.
• Do not break, crush, or chew the tablet.

Oral Liquid:

• Measure with a marked measuring spoon, oral syringe, or medicine cup.
• Do not use an average household teaspoon for measurement.

Regardless of the dosage form, it’s important to use albuterol only as directed by a doctor, not exceeding the prescribed dosage or frequency. Also, don’t stop using albuterol or any asthma medication without consulting a doctor, as doing so may lead to breathing problems.

For the dosing schedule of Albuterol, here’s a general outline:

Albuterol is a fast-acting medication to ease symptoms quickly. While its effects may not be immediate, individuals typically experience improvement within a few minutes to an hour after taking albuterol.

Potential Side Effects

Flovent Side Effects

While effective in controlling asthma symptoms, Flovent is also associated with potential side effects. Here’s a breakdown of both the common and serious side effects individuals should be aware of when using Flovent

Common Flovent HFA Inhaler Side Effects

• Upper respiratory tract infection
• Throat and/or sinus irritation
• Headache
• Diarrhea
• Difficulty speaking
• Cough and/or persistent cough

Common Flovent Diskus Inhaler Side Effects

• Upper respiratory tract infection
• Throat, nose, and/or sinus irritation
• Nausea and vomiting
• Cough and/or persistent cough
• Fever
• Headache
• Upset stomach

Serious side effects

• Fungal infections in the mouth or throat (thrush)
• Weakened immune system and increased risk of infections (Immunosuppression)
• Reduced adrenal function (symptoms are feeling tired, lack of energy, weakness, nausea and vomiting, and low blood pressure)
• Serious allergic reactions (symptoms are tiredness, rash, hives, swelling of the face, throat, and tongue, breathing problems)
• Bone thinning or weakness (Osteoporosis)
• Slowed growth in children
• Eye problems (including glaucoma, increased eye pressure, cataracts, or changes in vision)
• Increased wheezing (Bronchospasm)

Albuterol Side Effects

The primary adverse effects of albuterol therapy include:

• Tremors and nervousness, predominantly observed in children aged 2 to 6
• Insomnia
• Nausea

Less common adverse effects may include:

• Fever
• Bronchospasm
• Vomiting
• Headache
• Dizziness
• Cough
• Otitis media
• Epistaxis
• Increased appetite
• Urinary tract infections
• Dry mouth
• Gas
• Hyperhidrosis
• Dyspepsia
• Hyperactivity
• Chills
• Lymphadenopathy
• Ocular pruritus
• Sweating
• Conjunctivitis
• Dysphonia

Albuterol may also:

• Raise blood pressure levels
• Cause hypokalemia

Rare occurrences include:

• Increased blood glucose concentrations
• Prolonged QTc interval
• ST-segment depression

Precautions, Warnings, and Possible Interactions

Flovent’s Warnings and Precautions

When considering the use of Flovent, be mindful of potential warnings and precautions. These include:

• Local effects: Candida albicans infections of the mouth and pharynx may occur. Patients should rinse their mouth after inhalation to reduce the risk.

• Acute asthma episodes: Flovent is not for immediate relief of bronchospasm. Patients experiencing non-responsive asthma episodes should contact their physician immediately.

• Immunosuppression: Prolonged use of high doses of corticosteroids can potentially lead to immunosuppression. Patients using immunosuppressive drugs are more susceptible to infections, including chickenpox and measles.

• Transferring patients from systemic corticosteroid therapy: Due to the risk of deaths from adrenal insufficiency observed in asthma patients during and after transitioning from systemic corticosteroids to inhaled corticosteroids, special attention is needed for these patients. This is due to the extended period required for the hypothalamic-pituitary-adrenal (HPA) function to fully recover after discontinuing systemic corticosteroids.

• Hypercorticism and adrenal suppression: Has the potential to suppress the hypothalamic-pituitary-adrenal (HPA) axis function. Prolonged or high-dose use of corticosteroids can affect the body’s natural production of cortisol, causing hypercorticism. However, the degree of HPA axis suppression with inhaled corticosteroids like Flovent is generally lower compared to systemic corticosteroids.

• Reduction in bone mineral density: Long-term use of inhaled corticosteroids may decrease bone mineral density. Patients with major risk factors for decreased bone mineral content should be monitored and treated accordingly.

• Effect on growth: Orally inhaled corticosteroids may reduce growth velocity in pediatric patients.

• Glaucoma and cataracts: Long-term use of inhaled corticosteroids, including Flovent, may increase the risk of glaucoma, increased intraocular pressure, and cataracts. Monitoring is warranted in patients with changes in vision or a history of these conditions.

• Paradoxical bronchospasm: Bronchospasm may occur immediately after dosing with Flovent. If bronchospasm occurs, treatment should be discontinued immediately, and alternative therapy instituted.

• Eosinophilic conditions: Rare cases of systemic eosinophilic conditions, including Churg-Strauss syndrome, have been reported with inhaled corticosteroids. Physicians should be alert to symptoms such as vasculitic rash and worsening pulmonary symptoms.

Flovent’s Contraindications

The use of Flovent is contraindicated in the following conditions:

• Hypersensitivity reactions, including anaphylaxis, angioedema, urticaria, and bronchospasm, may occur with Floven. Additionally, patients with severe milk protein allergy should avoid Flovent Diskus due to reports of anaphylactic reactions.

• Main therapy for severe asthma attacks or acute episodes of asthma requiring intensive measures.

Drug Interactions with Flovent

According to Drugs.com, 103 drugs are known to interact with Flovent (fluticasone). Among these, 36 are major drug interactions, 52 are moderate and 15 are minor. These include:

Albuterol Warnings and Precautions

The warnings and precautions associated with the use of albuterol include:

• Cardiovascular effects: Albuterol sulfate inhalation aerosol, like other beta-adrenergic agonists, can cause cardiovascular effects such as changes in pulse rate and blood pressure. Although rare at recommended doses, if these occur, discontinuing the drug may be necessary.

• Asthma deterioration: Asthma can worsen suddenly within hours or gradually over days. If there’s a greater need for albuterol, it could indicate asthma destabilization, requiring a reassessment of the patient and treatment plan. It’s important to consider adding anti-inflammatory medications like corticosteroids in such cases.

• Use of anti-inflammatory agents: Using only beta-adrenergic agonist bronchodilators may not be enough and could harm patient outcomes. That’s why it’s crucial to think about adding ICS early on.

• Paradoxical bronchospasm: This reaction is often associated with the benzalkonium chloride preservative in albuterol nebulizers. Paradoxical bronchospasm is a rare but serious side effect of bronchodilator medications like albuterol. Instead of relaxing and opening up the airways as intended, these medications can sometimes cause the muscles around the airways to tighten, making it harder to breathe. It’s a paradox because the medication that’s supposed to help with breathing actually ends up making it worse. This reaction can be alarming and requires immediate medical attention.

Albuterol’s Contraindications

Albuterol should not be used in cases of hypersensitivity. For individuals with milk protein hypersensitivity, it’s recommended to avoid albuterol formulations containing lactose as an ingredient.

Drug Interactions with Albuterol

According to Drugs.com, 419 drugs are known to interact with albuterol. Among these, 19 are major drug interactions, 381 are moderate and 19 are minor. These include:

Cost and Alternatives

Cost

According to GoodRx data, the price of Flovent HFA in US pharmacies ranges from $260 to $590 while Flovent Diskus ranges from $255 to $450. On the other hand, price range of common brand names of albuterol are as follows:

• ProAir HFA inhaler: starts at $90
• Proventil HFA inhaler: starts at $100
• Ventolin HFA inhaler: starts at $70

These prices depend on the dosage, actuations, and the pharmacy. To save on Flovent or albuterol, consider the following strategies:

• Use generic versions: Generic versions of these medications may be available at a lower cost compared to brand-name options.

• Shop around: Prices for medications can vary between pharmacies. Compare prices at different pharmacies and consider using discount programs or coupons.

• Consider Canadian pharmacies: Purchasing medications from Canadian pharmacies may offer cost savings. One reputable option is Pharma Giant where customers can save up to 90% on prescription medications. For example, the prices of Flovent HFA start at $64, Flovent Diskus start at $48, and Ventolin Diskus start at $59. Generic versions are also available, which can provide further savings.

Additionally, customers can benefit from additional discounts and promotions, particularly when ordering larger quantities. New customers can take advantage of the coupon code PGSAVE10, which provides a 10% discount on their initial order. Pharma Giant also ensures convenient service with expedited delivery, typically within 3-5 business days.

• Ask about assistance programs: Some pharmaceutical companies offer patient assistance programs or discounts for those who qualify.

• Review your insurance coverage: Check your insurance plan to see if Flovent or albuterol are covered, and if there are any preferred pharmacies or formularies that offer lower copays.

• Discuss alternatives with your doctor: Your healthcare provider may be able to recommend alternative medications or treatment options that are more affordable.

Alternatives

Alternative to Flovent

In June 2023, GlaxoSmithKline (GSK), the manufacturer of Flovent, notified the FDA that they would stop producing Flovent products starting January 1, 2024. This includes both Flovent HFA and Flovent Diskus. Despite this discontinuation, numerous alternative brands to Flovent offer comparable effects.

Flovent belongs to the class of medications known as inhaled corticosteroids. Other inhalers within this category include:

• Pulmicort Flexhaler (budesonide)
• QVar (beclomethasone)
• Asmanex Twisthaler (mometasone furoate)
• Alvesco (ciclesonide)

Healthcare providers may also suggest combination inhalers based on the patient’s symptoms. Some popular examples include:

• Advair Diskus (fluticasone propionate/salmeterol xinafoate)
• Advair HFA Inhaler (fluticasone propionate/salmeterol xinafoate)
• Breo Ellipta (fluticasone furoate/vilanterol)
• Symbicort Inhaler (budesonide/formoterol fumarate dihydrate)

Alternative to Albuterol

Albuterol is marketed under various brand names such as ProAir, Ventolin, and Proventil. At times, patients may consider switching to a substitute for albuterol due to factors like cost, inhaler usability challenges, or supply shortages from the manufacturer.

For those seeking an alternative to albuterol, here are some commonly recommended options:

• Breztri Aerosphere (budesonide/formoterol fumarate/glycopyrrolate)
• Spiriva (tiotropium)
• Combivent Inhaler (ipatropium bromide/albuterol)
• Xopenex HFA (levalbuterol)
• Primatene Mist (epinephrine)

Wrap-Up

Flovent and Albuterol serve distinct purposes in managing asthma, each offering unique mechanisms of action and treatment approaches. Flovent, categorized as a long-acting corticosteroid, operates by exerting anti-inflammatory effects to prevent asthma attacks.

On the other hand, Albuterol functions as a short-acting beta-2 adrenergic agonist, swiftly relaxing the muscles within the airways during asthma episodes.

Despite their efficacy, both Flovent and Albuterol may induce side effects like coughing, headache, and tremors. Therefore, it’s important to seek guidance from a healthcare provider to determine the most suitable medication and dosage regimen.

Frequently Asked Questions