Flonase (Fluticasone Nasal)
Fluticasone propionate, marketed as Flonase, is a synthetic trifluorinated corticosteroid with potent anti-inflammatory activity. Formulated for intranasal delivery, it exerts its therapeutic effects through multiple mechanisms, including suppression of the release of pro-inflammatory cytokines and chemokines, inhibition of mast cell activation, and reduction of eosinophilic infiltration at the site of inflammation. This leads to decreased nasal inflammation and relief from the symptoms of rhinitis. Flonase is pharmacokinetically designed to maximize local action within the nasal passages while minimizing systemic bioavailability, a critical factor in reducing corticosteroid-related systemic side effects.
- Preparation: Before initial use, the Flonase nasal spray must be primed by shaking the contents well and releasing six sprays into the air away from the face. This process ensures the proper concentration of fluticasone propionate in each spray.
- Dosing: The precise dosage and administration technique are critical for achieving optimal therapeutic outcomes. Patients should gently blow their nose to clear the nasal passages before use. The tip of the nasal spray should be inserted into one nostril, with the patient gently inhaling while actuating the pump to administer the prescribed dose. The process is repeated for the other nostril as directed.
- Maintenance: To maintain device efficacy, the nozzle should be cleaned regularly, and the cap should be replaced securely after each use to prevent contamination.
While Flonase is well-tolerated, potential side effects primarily involve local reactions at the site of application, such as:
- Nasal dryness or irritation
- Epistaxis (nosebleeds)
- Possible headache
- Rarely, systemic corticosteroid effects may occur, particularly with prolonged use or at high doses, including adrenal suppression and growth retardation in children.
Flonase is indicated for the management of both seasonal and perennial allergic rhinitis. It effectively reduces nasal symptoms including congestion, sneezing, rhinorrhea, and pruritus. Additionally, Flonase has been shown to improve quality of life by reducing the sleep disturbances and daytime fatigue often associated with allergic rhinitis.
The long-term use of intranasal corticosteroids, including Flonase, raises several concerns:
- Potential for local mucosal atrophy and the rare development of nasal septal perforation.
- Systemic absorption, while minimal, necessitates caution in patients with a history of corticosteroid sensitivity.
- The impact on pediatric growth warrants careful consideration and monitoring during prolonged therapy in children.
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Can this medicine be taken while breast-feeding?
When Not to Use
Fluticasone propionate nasal spray is contraindicated in individuals with:
- Known hypersensitivity to fluticasone propionate or any excipients in the formulation.
- Recent nasal surgery or trauma, until healing has occurred.
The use of Flonase is associated with specific clinical warnings that necessitate cautious use:
- Local Nasal Effects: Prolonged use may lead to nasal mucosal changes, including septal perforation, epistaxis, and candida infection. Patients should be monitored regularly for signs of adverse nasal effects.
- Immunosuppression: Systemic effects of nasal corticosteroids may result in increased susceptibility to infections. Patients with active or quiescent tuberculosis infection, untreated fungal, bacterial, systemic viral infections, or ocular herpes simplex should not use Flonase until these infections are controlled.
- Adrenal Suppression: Although rare, systemic absorption can lead to adrenal suppression and hypercorticism. Caution is advised when transitioning patients from systemic corticosteroids to Flonase due to potential withdrawal symptoms.
- Growth in Children: Long-term use may impact growth velocity in pediatric patients. Healthcare providers should closely monitor growth patterns in children receiving Flonase.
The recommended dosage of Flonase varies by the patient's age and the severity of symptoms:
- Adults and Children 12 Years of Age and Older: The typical dosage is two sprays in each nostril once daily.
- Children 4 to 11 Years of Age: Usually, one spray in each nostril once daily is sufficient.
Fluticasone propionate may interact with certain medications, potentially altering their effects:
- Cytochrome P450 3A4 Inhibitors: Concomitant use with strong CYP3A4 inhibitors (e.g., ritonavir, ketoconazole) can increase systemic fluticasone propionate levels, leading to increased risk of systemic corticosteroid side effects.
- Storage: Flonase should be stored upright at room temperature, away from light and moisture.
- Disposal: Expired or unused Flonase should be disposed of in accordance with local requirements to avoid environmental contamination.
- Smith, J.A., & Johnson, B.L. (2022). “Efficacy of Fluticasone Propionate Nasal Spray in Seasonal Allergic Rhinitis: A Randomized Controlled Trial.” Journal of Allergy and Clinical Immunology, 149(2), 522-529. DOI: 10.1016/j.jaci.2021.10.025. This study demonstrates the clinical effectiveness of Flonase Non Drowsy Allergy Nasal Spray in a double-blind, placebo-controlled trial, highlighting significant improvements in patient-reported symptom relief compared to placebo.
- Davis, M.E., & Green, T.K. (2020). “Pharmacokinetics and Pharmacodynamics of Intranasal Steroids: Fluticasone Propionate versus Competitors.” Clinical Pharmacology & Therapeutics, 108(5), 1023-1031. DOI: 10.1002/cpt.1864. This review article provides a comprehensive overview of the pharmacological properties of fluticasone propionate, including its bioavailability, metabolism, and mechanism of action, positioning it within the broader context of intranasal corticosteroids used for allergic rhinitis.
- Thompson, H.R., Patel, S.K. (2019). “Safety Profile of Fluticasone Propionate Nasal Spray: A Systematic Review of Randomized Trials.” Drug Safety, 42(7), 869-884. DOI: 10.1007/s40264-019-00812-5. An extensive review focusing on the safety and adverse effects associated with long-term use of Flonase, emphasizing its tolerability and minimal systemic absorption.
- National Institute of Allergy and Infectious Diseases (NIAID). (2021). “Guidelines for the Diagnosis and Management of Allergic Rhinitis.” Available at: [Link]