Brand Names for Inhaled Corticosteroids (ICS)
The main brand names for inhaled corticosteroids (ICS) include Flovent/Flixotide (fluticasone propionate), Pulmicort (budesonide), Qvar (beclomethasone dipropionate), Asmanex (mometasone), Alvesco (ciclesonide), Aerospan (flunisolide), and Azmacort (triamcinolone). 1
Available ICS Medications and Their Brand Names
Inhaled corticosteroids are the cornerstone of asthma management for persistent asthma due to their potent anti-inflammatory effects. They reduce airway hyperresponsiveness, inhibit inflammatory cell migration and activation, and block late-phase reactions to allergens 2. The following are the major ICS medications available:
Single-Agent ICS Products
Fluticasone propionate
- Brand names: Flovent (US), Flixotide (Europe) 3
- Available in MDI and dry powder devices (Diskus)
- Dosages range from 44-500 mcg/puff
Budesonide
- Brand name: Pulmicort Turbuhaler/Flexhaler
- Available in dry powder inhaler and nebulizer solution
Beclomethasone dipropionate
- Brand names: Qvar, Beclovent
- Available in HFA-propelled MDI formulation 4
Mometasone furoate
- Brand name: Asmanex
- Available in dry powder inhaler 4
Ciclesonide
- Brand name: Alvesco
- Available in HFA-propelled MDI 1
Flunisolide
- Brand name: Aerospan (formerly Aerobid)
- Available in HFA-propelled MDI 4
Triamcinolone acetonide
- Brand name: Azmacort
- Available in MDI 1
Combination ICS/LABA Products
ICS are also available in fixed-dose combinations with long-acting beta-agonists (LABAs):
Fluticasone propionate/Salmeterol
- Brand names: Advair (US), Seretide (Europe), Adoair (Japan) 5
Budesonide/Formoterol
- Brand name: Symbicort 5
- Also approved in some countries as maintenance and reliever therapy (Symbicort SMART)
Beclomethasone/Formoterol
- Brand name: Foster 5
Relative Potency of Different ICS Products
When switching between different ICS products, it's important to consider their relative potencies:
- Fluticasone propionate is approximately twice as potent as beclomethasone dipropionate, budesonide, or triamcinolone acetonide 3
- The potency ratio between Flixotide Diskus (fluticasone propionate) and Pulmicort Turbuhaler (budesonide) is approximately 1.5:1 to 1.75:1 6
Delivery Devices
ICS are delivered through various devices that may affect drug delivery and clinical efficacy:
- Metered Dose Inhalers (MDIs): Most ICS are available in MDI format, many now using HFA propellants
- Dry Powder Inhalers (DPIs): Including Diskus/Accuhaler, Turbuhaler/Flexhaler
- Nebulizers: Particularly useful for young children, elderly patients, or those with coordination difficulties 7
Clinical Considerations
When prescribing ICS, several factors should be considered:
- For patients with persistent asthma, ICS are the most consistently effective long-term control medication at all steps of care 2
- ICS improve asthma control more effectively than leukotriene receptor antagonists or any other single long-term control medication 2
- Combination therapy with ICS and LABA in a single inhaler may provide better asthma control than administering the drugs in separate inhalers 8
Pitfalls and Caveats
- LABAs should never be used as monotherapy for asthma control; they must always be prescribed with an ICS 2
- Different ICS products and delivery devices have varying lung deposition characteristics, which can affect clinical efficacy 7
- When switching between different ICS products, dose adjustments may be necessary due to differences in potency 6
- High-dose ICS therapy may be associated with systemic effects, including potential adrenal suppression 9
By understanding the available ICS products and their brand names, clinicians can make informed decisions when prescribing these essential medications for asthma management.