Dosing and uses of Flunisolide intranasal
Adult dosage forms and strengths
nasal spray
- 25mcg/actuation
- 29mcg/actuation
Seasonal Allergic Rhinitis
2 sprays each nostril BID; may increase to TID/QId
Administration
Prime spray by actuating 5-6 times first before use, if it has not been used for >4 days, or if it has been disassembled for cleaning
Pediatric dosage forms and strengths
nasal spray
- 25mcg/actuation
- 29mcg/actuation
Seasonal Allergic Rhinitis
<6 years: Safety and efficacy not established
6-14 years: 1 spray each nostril TID, or 2 sprays each nostril BId
Administration
Prime spray by actuating 5-6 times first before use, if it has not been used for >4 days, or if it has been disassembled for cleaning
Flunisolide intranasal adverse (side) effects
>10%
Nasal burning/stinging (13-44%)
Aftertaste (8-17%)
1-10%
Nausea
Epistaxis
Nasal dryness
Pharyngitis
Cough increased
<1%
Hoarseness
Nasal ulceration
Abnormal sense of smelL
Sinusitis
Vertical growth suppression
Warnings
Contraindications
Hypersensitivity
Do not use with untreated local infection involving the nasal mucosa
Recent nasal surgery/injury
Cautions
Replacement of systemic corticosteroids with topical administration can be accompanied by signs of adrenal insufficiency: some patients may experience withdrawal symptoms
Intranasal corticosteroids may cause a reduction in growth velocity when administered to pediatric patients Rare reports of nasal septal perforation
Temporary or permanent loss of sense of smell or taste reported
Because of the inhibitory effect of corticosteroids on wound healing, a nasal corticosteroid should be used with caution in patients who have experienced recent nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma, until healing has occurred
Systemic corticoid effects typical of Cushing's syndrome are minimal with recommended doses of topical steroids, this potential increases with excessive doses
Corticosteroids are known to cause immunosuppression resulting in increased susceptibility to infection
Pregnancy and lactation
Pregnancy category: C
Lactation: Corticosteroids are known to be secreted in breast milk
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 Flunisolide intranasal
Mechanism of action
Elicits potent glucocorticoid and weak mineralocorticoid effects; provides direct anti-inflammatory actions to nasal mucosa
Absorption
Bioavailability: 50% (intranasal); 20% (PO) due high first-pass liver metabolism
Metabolism
Converted by the liver to the much less active primary metabolite and to glucuronide and sulfate conjugates
Elimination
Half-life: 1-2 hr
Excretion: 50% feces; 50% urine
