Class: Intranasal Adrenal Glucocorticosteroid
Dosage Forms. Nasal Spray: 25 mcg/actuation, 50 mcg/actuation
Common FDA Label Indication, Dosing, and Titration.
1. Allergic rhinitis: Children 4 y of age and older and Adults, 2 sprays/nostril daily or 1 spray/nostril bid; max of 2 sprays/nostril/d (200 mcg/d)
2. Nonallergic rhinitis: Children 4 y of age and older and Adults, 2 sprays/nostril daily or 1 spray/nostril bid; max of 2 sprays/nostril/d (200 mcg/d)
1. Nasal polyps: 1 spray/nostril bid
MOA. Fluticasone has anti-inflammatory, antipruritic, and vasoconstrictive properties. Corticosteroids are thought to act by the induction of phospholipase A2-inhibitory proteins, lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.
Drug Characteristics: Fluticasone Nasal Inhaler
Medication Safety Issues: Fluticasone Nasal Inhaler
Drug Interactions: Fluticasone Nasal Inhaler
Adverse Reactions: Fluticasone Nasal Inhaler
Efficacy Monitoring Parameters. Control of rhinitis signs and symptoms.
Toxicity Monitoring Parameters. While only small amounts of fluticasone reach systemic circulation, bone mineral density and growth and development in children should be monitored. Routine ophthalmologic examinations should be performed. Monitor for signs and symptoms of adrenal suppression or infection.
Key Patient Counseling Points. Advise patients on the proper administration technique for this product. Instruct patients to monitor for signs of toxicity, especially adrenal insufficiency.
Clinical Pearls. Oral inhalation and topical dosage forms of fluticasone also available for treatment of other allergic disorders. While oral antihistamines (either OTC or prescription) remain the mainstay for treatment of rhinitis, nasal steroids are a recommended option if symptoms are severe, unresolved with oral antihistamines, or if oral antihistamines cause undesirable adverse effects.