1. Introduction
Fluticasone nasal spray and drops are intranasal corticosteroids used to manage nasal inflammation caused by allergic and non-allergic rhinitis, nasal polyps, and sinus conditions. They reduce swelling, congestion, itching, and mucus production in the nasal passages by suppressing inflammatory mediators.
2. Indications
- Approved Indications:
- Allergic rhinitis (seasonal and perennial).
- Non-allergic rhinitis.
- Nasal polyps.
- Chronic rhinosinusitis (with or without nasal polyps).
- Off-Label Uses:
- Eosinophilic sinusitis.
3. Dosage
- Adults and Adolescents (≥12 years):
- Nasal Spray: 50 mcg per spray.
- Allergic rhinitis: 2 sprays in each nostril once daily (200 mcg total). Maintenance dose: 1 spray per nostril once daily.
- Nasal Drops: 400 mcg once daily or divided into 2 doses (200 mcg per nostril).
- Nasal Spray: 50 mcg per spray.
- Children (4–11 years):
- Nasal Spray: 1 spray per nostril once daily (100 mcg total).
- Children (<4 years):
- Not typically recommended without specialist advice.
4. Administration
- Nasal Spray:
- Shake well before use.
- Clear your nasal passages by gently blowing your nose.
- Spray into each nostril while keeping your head upright and avoid sniffing hard immediately after spraying.
- Nasal Drops:
- Tilt your head backward or lie down with your head tilted back.
- Instil drops into each nostril as prescribed, then remain in the same position for a few minutes.
5. Forms Available
- Nasal Spray: 50 mcg per spray.
- Nasal Drops: 400 mcg/mL.
6. Side Effects
6.1. Common Side Effects
- Nasal dryness or irritation.
- Sneezing after application.
- Mild nosebleeds.
6.2. Less Common Side Effects
- Headache.
- Sore throat.
- Altered taste or smell.
6.3. Rare but Serious Side Effects
- Nasal septum perforation.
- Increased intraocular pressure (glaucoma).
- Hypersensitivity reactions (e.g., rash, swelling).
7. Warnings
- Nasal Septum Perforation: Avoid spraying directly onto the nasal septum; aim towards the outer wall of the nostril.
- Infections: May mask signs of infections or worsen existing infections (e.g., untreated nasal fungal infections).
- Systemic Absorption: Prolonged use or high doses may lead to systemic corticosteroid effects.
8. Precautions
- Use cautiously in patients with a history of frequent nosebleeds or nasal surgery.
- Avoid long-term use unless prescribed, and monitor for side effects during prolonged therapy.
9. Interactions
- Drug-Drug Interactions:
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): May increase systemic corticosteroid levels and side effects.
- Drug-Food Interactions:
- No significant food interactions.
10. Monitoring Parameters
- Symptom relief (e.g., reduced nasal congestion, sneezing, or runny nose).
- Signs of nasal irritation or dryness.
- Monitor for systemic side effects in prolonged therapy.
11. Use in Children
- Safe for children aged 4 years and older when used at recommended doses. Monitor for growth suppression during prolonged use.
12. Use in Pregnancy
- Category C: Use only if benefits outweigh risks. Intranasal corticosteroids are generally preferred for managing rhinitis during pregnancy due to minimal systemic absorption.
13. Use in Elderly
- Safe for elderly patients, but monitor for potential side effects like nasal irritation or dryness.
14. Use in Kidney Disease
- No dose adjustment is required, as fluticasone is not renally excreted.
15. Use in Liver Disease
- Use cautiously in severe liver impairment, as systemic absorption may increase slightly.
16. Patient Counselling Points
- Use fluticasone nasal spray or drops regularly as prescribed to achieve the best symptom control.
- Avoid spraying directly onto the nasal septum to reduce the risk of irritation or perforation.
- Rinse the spray tip or dropper with warm water after each use to maintain hygiene.
- Inform your doctor if you experience persistent nosebleeds, severe irritation, or vision changes.
- Do not share your nasal spray or drops with others to prevent infections.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Flonase | GlaxoSmithKline | $20–40 (120 sprays, 50 mcg per spray) |
Avamys | GlaxoSmithKline | $25–50 (120 sprays, 50 mcg per spray) |
Generic Fluticasone | Various | $10–30 (120 sprays, 50 mcg per spray) |
18. FAQs (15 Questions)
- What is fluticasone nasal spray used for?
It is used to treat nasal symptoms of allergies, such as sneezing, congestion, and runny nose, and for nasal polyps. - How does fluticasone work?
It reduces nasal inflammation by suppressing inflammatory mediators in the nasal passages. - How long does it take for fluticasone to work?
Symptom relief may begin within 12–24 hours, but full effects may take several days to a week. - Can fluticasone cause nosebleeds?
Yes, mild nosebleeds are a common side effect. Avoid spraying directly on the nasal septum to reduce this risk. - Can fluticasone be used during pregnancy?
Yes, it may be used if necessary and prescribed by a doctor, as it has minimal systemic absorption. - How should I use fluticasone nasal spray?
Shake the bottle, clear your nose, aim the spray towards the outer wall of the nostril, and avoid sniffing hard immediately after use. - What are the common side effects of fluticasone?
Common side effects include nasal irritation, dryness, sneezing, and mild nosebleeds. - Can children use fluticasone nasal spray?
Yes, it is approved for children aged 4 years and older, with appropriate dosing. - How should fluticasone nasal spray be stored?
Store at room temperature, away from direct sunlight and moisture. - Does fluticasone interact with other medications?
CYP3A4 inhibitors (e.g., ritonavir) may increase the risk of systemic side effects. - Can I use fluticasone nasal spray long-term?
Yes, under medical supervision. Monitor for side effects during prolonged use. - What should I do if I miss a dose?
Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double up. - Can fluticasone cause systemic side effects?
Rarely, at high doses or with prolonged use, systemic corticosteroid effects like adrenal suppression may occur. - Can I use fluticasone nasal spray with other allergy medications?
Yes, it can be combined with antihistamines or decongestants if needed. - Is fluticasone nasal spray over-the-counter?
In many countries, fluticasone nasal spray is available without a prescription for mild to moderate allergic rhinitis.