Fluticasone Intranasal

Fluticasone intranasal is a prescription as well as over-the-counter medicine used to treat the symptoms of allergic rhinitis and nasal polyps.

• Fluticasone intranasal is available under the following different brand names: Flonase Allergy Relief, ClariSpray, Flonase Sensimist Allergy Relief, Children's Flonase Allergy Relief, Veramyst, Xhance, FlutiCare

Adult and pediatric dosage

Nasal spray

• 27.5mcg/actuation (Flonase Sensimist Allergy Relief [OTC])
• 50mcg/actuation (Flonase Allergy Relief [OTC], ClariSpray [OTC], FlutiCare [OTC])
• 93 mcg/actuation (Xhance [Rx])

Allergic Rhinitis

• Adult dosage
  • Flonase Allergy Relief: 1 spray in each nostril (100 mcg/day) for maintenance therapy; OTC not for use for more than 6 months unless instructed by a healthcare provider
  • ClariSpray, FlutiCare: 2 sprays in each nostril once daily for 1 week, then 1-2 sprays in each nostril once daily as needed to treat symptoms for up to 6 months unless directed by a physician to use longer
  • Flonase Sensimist Allergy Relief: 2 sprays in each nostril once daily (ie, 110 mcg/day); after symptoms are controlled, may reduce dose to 1 spray in each nostril once daily (ie, 55 mcg/day) for maintenance therapy
• Pediatric dosage
• Flonase Allergy Relief, Children's Flonase Allergy Relief
  • Children between 4 to 11 years: 1 spray (50 mcg) in each nostril once daily; may increase up to 2 sprays/nostril once daily if not responding adequately, reduce to 1 spray in each nostril once daily once symptoms are controlled
  • Children above 12 years: 2 sprays in each nostril once daily (ie, 200 mcg/day); reduce to 1 spray in each nostril once daily once symptoms are controlled
• ClariSpray, FlutiCare
  • Children below 4 years: Safety and efficacy not established
  • Children between 4 to 11 years: 1 spray in each nostril once daily for up to 2 months annually unless directed by a physician to use longer
  • Children above 12 years: 2 sprays in each nostril once daily for 1 week, then 1-2 sprays in each nostril once daily as needed to treat symptoms for up to 6 months unless directed by a physician to use longer
• Flonase Sensimist Allergy Relief
  • Children between 2 to 12 years: 1 spray (27.5 mcg) in each nostril once daily; may increase up to 2 sprays/nostril once daily if not responding adequately, reduce to 1 spray in each nostril once daily once symptoms are controlled
  • Children above 12 years: 2 sprays in each nostril once daily (ie, 110 mcg/day); reduce to 1 spray in each nostril once daily once symptoms are controlled

Nasal Polyps

Adult dosage

• Xhance: 1 spray in each nostril every 12 hours (372 mcg/day); not to exceed 2 sprays in each nostril every 12 hours (744 mcg/day)

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Fluticasone intranasal include:

• minor nosebleed,
• burning or itching in the nose,
• sores or white patches inside or around the nose,
• cough,
• trouble breathing,
• headache,
• back pain,
• sinus pain,
• sore throat,
• fever,
• nausea, and
• vomiting.

Serious side effects of Fluticasone intranasal include:

• severe or ongoing nosebleeds,
• noisy breathing,
• runny nose,
• crusting around the nostrils,
• redness, sores, or white patches in the mouth or throat,
• fever,
• chills,
• body aches,
• blurred vision,
• eye pain,
• seeing halos around lights,
• wounds that will not heal,
• worsening tiredness,
• muscle weakness, and
• lightheadedness.

Rare side effects of Fluticasone intranasal include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Fluticasone intranasal has severe interactions with no other drugs.
• Fluticasone intranasal has serious interactions with at least 22 other drugs.
• Fluticasone intranasal has moderate interactions with the following drugs:
  • fedratinib
  • letermovir
  • ribociclib
  • rucaparib
  • stiripentol
  • tazemetostat
• Fluticasone intranasal has minor interactions with no other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity to fluticasone or ingredients

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Fluticasone intranasal?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Fluticasone intranasal?”

Cautions

• May mask acute infection, including fungal infection, exacerbate viral infections or limit response to vaccines; not for use in untreated localized infection involving nasal mucosa; administer antimicrobial therapy if bacterial infection of sinuses suspected or confirmed; respiratory tract fungal or bacterial infections, parasitic infections, ocular herpes simplex may occur
• Chickenpox and measles: Serious or fatal course in susceptible individuals; unvaccinated or immunologically unexposed children or adults should avoid exposure
• Delays wound healing of nasal septal ulcers, trauma, or surgery; best to administer after healing has occurred
• May increase risk of hypercorticism or hypothalamic-pituitary-adrenal (HPA) axis suppression, especially in younger patients receiving high doses for prolonged periods; HPA suppression may lead to an adrenal crisis; withdraw or discontinue slowly; pediatric patients may be more susceptible to systemic toxicity
• Nasal corticosteroids, including fluticasone propionate, may result in the development of glaucoma and/or cataracts; closely monitor vision changes or patients with a history of increased intraocular pressure (IOP), glaucoma, and/or cataracts
• Systemic corticosteroids have been shown to cause a reduction in growth velocity in children and adolescents; monitor growth while taking intranasal corticosteroids
• Decreases in bone mineral density (BMD) have been observed with long-term oral inhalation of products containing corticosteroids into lungs; monitor and appropriately treat patients with major risk factors for decreased bone mineral content (eg, prolonged immobilization, family history of osteoporosis, postmenopausal status, tobacco use, advanced age, poor nutrition, or chronic use of drugs that can reduce bone mass [eg, anticonvulsants, oral corticosteroids])
• Avoid in patients with known hypersensitivity to fluticasone or any ingredient; see Contraindications
• Avoid concomitant use with strong CYP3A4 (eg, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, ketoconazole, telithromycin, conivaptan, lopinavir, voriconazole)
• Local nasal effects
  • Epistaxis, nasal erosions, and nasal ulcerations were reported
  • Nasal septal perforations have been reported; patients treated over several months or longer should be examined periodically for possible changes in the nasal mucosa
  • If a septal perforation is noted, discontinue treatment; avoid spraying directly on the septum
  • Localized Candida albicans infections have been observed; if such an infection develops, consider appropriate local therapy and discontinuation treatment; periodically examine for evidence of candidal infection in the nasal and oropharyngeal mucosa
  • Avoid use in patients who have experienced recent nasal ulcerations, nasal surgery, or nasal trauma

Pregnancy and Lactation

• Available data on inhaled or intranasal fluticasone propionate use in pregnant women have not reported a clear association with adverse developmental outcomes
• Fluticasone propionate crossed the placenta following subcutaneous administration to mice and rats and oral administration to rabbits
• Lactation
  • There are no available data on fluticasone propionate in human milk, effects on the breastfed child, or effects on milk production
  • Developmental and health benefits of breastfeeding should be considered and adverse effects on the breastfed child from treatment or an underlying maternal condition