Fluticasone Spray Drops

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).
  • 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 NameManufacturerPrice (USD)
FlonaseGlaxoSmithKline$20–40 (120 sprays, 50 mcg per spray)
AvamysGlaxoSmithKline$25–50 (120 sprays, 50 mcg per spray)
Generic FluticasoneVarious$10–30 (120 sprays, 50 mcg per spray)

18. FAQs (15 Questions)

  1. 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.
  2. How does fluticasone work?
    It reduces nasal inflammation by suppressing inflammatory mediators in the nasal passages.
  3. 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.
  4. Can fluticasone cause nosebleeds?
    Yes, mild nosebleeds are a common side effect. Avoid spraying directly on the nasal septum to reduce this risk.
  5. Can fluticasone be used during pregnancy?
    Yes, it may be used if necessary and prescribed by a doctor, as it has minimal systemic absorption.
  6. 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.
  7. What are the common side effects of fluticasone?
    Common side effects include nasal irritation, dryness, sneezing, and mild nosebleeds.
  8. Can children use fluticasone nasal spray?
    Yes, it is approved for children aged 4 years and older, with appropriate dosing.
  9. How should fluticasone nasal spray be stored?
    Store at room temperature, away from direct sunlight and moisture.
  10. Does fluticasone interact with other medications?
    CYP3A4 inhibitors (e.g., ritonavir) may increase the risk of systemic side effects.
  11. Can I use fluticasone nasal spray long-term?
    Yes, under medical supervision. Monitor for side effects during prolonged use.
  12. 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.
  13. Can fluticasone cause systemic side effects?
    Rarely, at high doses or with prolonged use, systemic corticosteroid effects like adrenal suppression may occur.
  14. Can I use fluticasone nasal spray with other allergy medications?
    Yes, it can be combined with antihistamines or decongestants if needed.
  15. Is fluticasone nasal spray over-the-counter?
    In many countries, fluticasone nasal spray is available without a prescription for mild to moderate allergic rhinitis.