fluticasone intranasal (Flonase Allergy Relief, ClariSpray, Flonase Sensimist Allergy Relief, Children's Flonase Allergy Relief, Veramyst)
Classes: Corticosteroids, Intranasal
Dosing and uses of Flonase Allergy Relief, ClariSpray (fluticasone intranasal)
Adult dosage forms and strengths
nasal spray
- 27.5mcg/actuation (Veramyst [Rx discontinued], Flonase Sensimist Allergy Relief [OTC])
- 50mcg/actuation (Flonase Allergy Relief [OTC], ClariSpray [OTC])
Perennial Nonallergic Rhinitis
Flonase Allergy Relief: 1 spray in each nostril (100 mcg/day) for maintenance therapy; OTC not for use for >6 months unless instructed by healthcare provider
ClariSpray: 2 sprays in each nostril qDay x 1 wk, THEN 1-2 sprays in each nostril qDay as needed to treat symptoms for up to 6 mo unless directed by physician to use longer
Flonase Sensimist Allergy Relief: 2 sprays in each nostril qDay (ie, 110 mcg/day); after symptoms controlled, may reduce dose to 1 spray in each nostril qDay (ie, 55 mcg/day) for maintenance therapy
Pediatric dosage forms and strengths
nasal spray
- 27.5mcg/actuation (Veramyst [Rx discontinued], Flonase Sensimist Allergy Relief [OTC])
- 50mcg/actuation (Flonase Allergy Relief [OTC], ClariSpray [OTC])
Seasonal/Perennial Allergic Rhinitis
Limit duration of use of OTC nasal corticosteroids to 2 months a year in children unless otherwise directed by physician
Flonase Allergy Relief, Children's Flonase Allergy Relief
- ≥4-11 years: 1 spray (50 mcg) in each nostril qDay; may increase up to 2 sprays/nostril qDay if not responding adequately, reduce to 1 spray in each nostril qDay once symptoms are controlled
- >12 years: 2 sprays in each nostril qDay (ie, 200 mcg/day); reduce to 1 spray in each nostril qDay once symptoms are controlled
ClariSpray
- <4 years: Safety and efficacy not estabished
- 4-11 years: 1 spray in each nostril qDay for up to 2 months annually unless directed by physician to use longer
- ≥12 years: 2 sprays in each nostril qDay x 1 wk, THEN 1-2 sprays in each nostril qDay as needed to treat symptoms for up to 6 mo unless directed by physician to use longer
Flonase Sensimist Allergy Relief
- 2-12 years: 1 spray (27.5 mcg) in each nostril qDay; may increase up to 2 sprays/nostril qDay if not responding adequately, reduce to 1 spray in each nostril qDay once symptoms are controlled
- >12 years: 2 sprays in each nostril qDay (ie, 110 mcg/day); reduce to 1 spray in each nostril qDay once symptoms are controlled
Flonase Allergy Relief, ClariSpray (fluticasone intranasal) adverse (side) effects
>10%
Headache (17%)
URI (15%)
1-10%
Nasal congestion (8%)
Pharyngitis (6-8%)
Asthma symptoms (3-7%)
Fever (1-5%)
Dysphonia (4%)
Cough (3-4%)
Nasal discharge (1-3%)
Aches and pains (1-3%)
Flu-like syndrome (1-3%)
Bronchitis (1-3%)
Diarrhea (1-3%)
Abdominal pain (1-3%)
Nasal ulcer (1%)
Frequency not defined
Loss of taste
Postmarketing Reports
Respiratory, thoracic, and mediastinal disorders: Rhinalgia, nasal discomfort (including nasal burning, nasal irritation, and nasal soreness), nasal dryness, and nasal septal perforation
Warnings
Contraindications
Hypersensitivity
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 adrenal crisis; withdraw or discontinue slowly; pediatric patients may be more sussceptible to systemic toxicity
Local nasal effects, nasal septum perforation, epistaxis, wheezing, cataracts, glaucoma reported; consider routine eye exams in long-term users or patients who report visual changes
Pregnancy and lactation
Pregnancy category: C
Lactation: Unknown whether distributed in breast milk; caution advised
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Flonase Allergy Relief, ClariSpray (fluticasone intranasal)
Mechanism of action
Potent anti-inflammatory corticosteroid with vasoconstrictive properties
Available in 2 salt forms, fluticasone propionate (Flonase) and fluticasone furoate (Veramyst)
Absorption
Bioavailability: ≤2%
Onset of action: May take several days to achieve optimum benefit