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Review Allergy Asthma Proc. 2007 Nov-Dec;28(6):671-87.

doi: 10.2500/aap.2007.28.2979.

A reappraisal of the clinical efficacy of nebulized

flunisolide in pediatric asthma: the Italian
experience
Ahmad Kantar 1 , Salman Mroueh, Alessandro Fiocchi

Affiliations
PMID: 17883883 DOI: 10.2500/aap.2007.28.2979

Abstract
Flunisolide (FLU) is a synthetic corticosteroid with potent topical anti-inflammatory activity. Its
oral bioavailability is poor (6.7%). After gastrointestinal and lung absorption, the drug
undergoes rapid and extensive first-pass metabolism by the liver to an inactive 6beta-
hydroxylated metabolite. Plasma half-life is estimated to be 3.9 to 4.6 hours. FLU has a low
volume of distribution at steady state and a short terminal half-life after inhalation (96 L and 1.6
hour, respectively). FLU, like budesonide, has a short pulmonary residence time and it is
hypothesized that it may undergo esterification in the cell due to the presence of a free
hydroxyl group at C21. Nebulization may offer important advantages over other inhalation
methods. Nebulizers allow drug delivery in very young children through passive inhalation,
depending less on patient coordination and cooperation. Comparative studies indicate that FLU
is nebulized to a better advantage than beclomethasone dipropionate and budesonide. This is
attributed to its elevated water solubility. The aim of this article is to outline the factors that
influence drug nebulization and the pharmacokinetics-pharmacodynamics of FLU compared to
other inhaled corticosteroids. In addition, we report a series of clinical data regarding the
efficacy of nebulized FLU with focus on the Italian experience. Overall, the physicochemical
characteristics and pharmacokinetic profile of FLU favor its use for nebulization. Clinical data
indicate that nebulized FLU is effective in asthma treatment in infants and children. Side effects
were not reported at the commonly used doses.

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