Fluticasone (Inhaled): veterinary dose and monograph

At a glance

Drug class

Veterinary drug

Also known as

Flixotide, Flovent, Fluticasone propionate

Species with doses

Dogs, Cats and Horses

Routes

Inhaled

Last reviewed

1 October 2026

Indications

• Feline asthma / chronic bronchitis — long-term maintenance anti-inflammatory control
• Canine chronic bronchitis (inhaled steroid maintenance)
• Equine inflammatory airway disease / recurrent airway obstruction (inhaled)
• Steroid maintenance where systemic side effects (e.g. diabetes) must be avoided

Fluticasone (Inhaled) dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• Chronic bronchitis (MDI + spacer + mask): Papich 5e: start 220 µg per dose q12h, decreasing gradually to 110 µg or lower. Plumb’s p.547: 110 or 220 µg (1 puff) q12h (Johnson 2007); 2 puffs of the 220 µg inhaler q12h (Hawkins 2009). Count 7–10 breaths through a tightly fitting mask.

Cats

• Asthma / chronic bronchitis (MDI + spacer + mask): Papich 5e: start 44 µg per dose q12h, increasing as needed to 110 then 220 µg. Plumb’s p.547: 44 µg one puff q12h (Cohn 2010 — all three strengths reduced airway eosinophils); 110 µg one puff q12h, 220 µg for more serious disease (Padrid). Let the cat breathe 7–10 times through the mask. Effect builds over 1–2 weeks — bridge with oral prednisolone.

Horses

• Inflammatory airway disease / RAO: Papich 5e: 1–2 mg per horse (6–12 puffs of 220 µg) twice daily; long term start 2 mg q24h and taper to 1.5 mg every other day. Plumb’s p.547 (Mazan): IAD 2200 µg (10 puffs) q12h for 2 weeks then q24h; RAO add 2200 µg q12h with salmeterol after systemic steroids, tapering to every other day; 6 mg q12h via EquineHaler (Robinson). Environmental control is essential.

Contraindications

Use as sole therapy for an acute asthma CRISIS (it is a controller, slow-onset — give salbutamol ± systemic steroid for the crisis). Active respiratory infection without cover (immunosuppression). Known hypersensitivity. Still has some systemic steroid potential at high doses/with hepatic impairment.

Species-specific warnings

Cats: A controller, not a reliever — always have salbutamol available for acute bronchospasm; ensure good mask/spacer technique for the inhaled steroid to work.

Adverse effects

• Generally minimal systemic effects (the advantage of inhalation)
• Oropharyngeal irritation; rarely local fungal overgrowth
• Some systemic absorption/HPA effect at high doses or with hepatic impairment
• No rapid relief (controller, not reliever)

Drug interactions

• CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin): reduce first-pass metabolism → MORE systemic steroid effect
• Salbutamol (reliever): complementary (give the bronchodilator first if both are used)
• Other immunosuppressants: additive immunosuppression

Pregnancy and lactation

Inhaled use gives low systemic exposure; generally considered acceptable when needed for airway control.

Monitoring

• Respiratory signs / control (cough, wheeze, respiratory rate/effort) over 1–2 weeks
• Need for rescue salbutamol (escalating use signals poor control)
• Inhalation technique (spacer + snug mask, adequate breaths)
• High-dose/long-term: signs of systemic steroid effect

Toxicity and overdose

Low systemic toxicity at usual inhaled doses (the point of inhalation), though high doses/CYP3A inhibition can produce systemic glucocorticoid effects (HPA suppression). Local effects (oropharyngeal irritation, rare fungal overgrowth) are minor. The main "failure" is using it for an acute crisis (too slow).

Management: No specific antidote. Excessive systemic steroid effect: reduce dose and manage as glucocorticoid excess (and taper if prolonged systemic exposure suppressed the HPA axis). Local effects: supportive. Supportive care.

Clinical pearls

• The maintenance controller for feline asthma — delivered by MDI + spacer + snug mask (AeroKat); high airway effect with minimal systemic steroid side effects (great for diabetic/steroid-sensitive cats)
• It is NOT a rescue drug: onset takes ~1–2 weeks, so cover acute bronchospasm with SALBUTAMOL (and systemic steroids for crises)
• Technique matters — a snug mask and ~7–10 breaths through the spacer per puff
• Beware CYP3A inhibitors (azoles, macrolides), which can convert it into a more systemic steroid

Mechanism of action

A high-potency glucocorticoid that binds cytoplasmic glucocorticoid receptors in airway cells, suppressing inflammatory gene transcription (cytokines, eicosanoids, leukocyte recruitment) and reducing airway inflammation, mucus and hyper-responsiveness. Delivered by inhalation, it achieves high local airway concentrations while swallowed drug undergoes extensive first-pass hepatic metabolism — giving potent local anti-inflammatory effect with limited systemic glucocorticoid exposure.

Formulations and products

• Metered-dose inhaler 50 / 110 / 125 / 220 / 250 mcg/puff
• Flixotide / Flohale — 50 / 125 / 250 mcg/puff MDI, Metered-dose inhaler (human-label)

Storage

MDI canisters: 15–30 °C, do not puncture/incinerate (pressurised); store with the spacer/mask. Prime as per device instructions.

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Other hormones, emergency drugs, supplements and other drugs

• Finasteride
• Fludrocortisone
• Flumazenil
• Fluoxetine
• Fomepizole (4-MP)
• Glipizide
• Glycopyrrolate
• Gonadorelin (GnRH)

Frequently asked questions