Inhaled and intranasal fluticasone propionate and haematoma

Fluticasone propionate is a locally acting potent corticosteroid and is registered in the Netherlands since November 1990. It is marketed as nasal drops and nasal spray (Flixonase) for the indications vasomotor and allergic rhinitis, nasal polyps, and as inhalation corticosteroid (ICS) (Flixotide) in both an inhalation dosisaerosol and a powder inhalation form for indications asthma and chronic obstructive pulmonary disease (COPD). Fluticason ICS is marketed also in combination with salmeterol, a long acting β2-agonist, (Seretide ) for asthma and COPD. Common local adverse drug reactions (ADR) include hoarseness, oropharyngeal fungal infections and paradoxal bronchoconstriction [1-3]. Systemic ADRs include suppression of the adrenal function, glaucoma, cataract, reduction of bone density and growth retardation in children [4]. Especially higher doses are related to the occurrence of systemic ADRs, yet large inter-personal differences exist. Haematoma, ecchymosis or purpura, due to an increased vascular vulnerability and thus an increased tendency to bruise, are well known adverse drug reactions (ADR) in systemic corticosteroids and ICSs [5]. In contrary to the SPCs of the fluticasone propionate preparations, these ADRs are mentioned in the SPCs of nasally acting corticosteroid preparations or ICSs containing budesonide or beclomethasone [6,7].