Flonase Overview

Flonase is a nasal spray containing fluticasone propionate, a corticosteroid used to manage allergic and non-allergic nasal symptoms. It is designed for intranasal administration and works by reducing inflammation and suppressing allergic reactions in the nasal passages.

Dosage and Administration

Flonase is administered as a nasal spray, with a recommended starting dosage of two sprays in each nostril once daily for adults and children aged 12 and above. For children aged 4-11, the dose is usually one spray per nostril once daily. Each spray delivers 50 micrograms of fluticasone propionate.

Mechanism of Action

Flonase works by inhibiting multiple cell types and mediators involved in the inflammatory process. Specifically, it inhibits the action of mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils. By doing so, it reduces the release of substances like histamine and cytokines that cause allergic reactions.

Indications for Use

Flonase is indicated for the treatment of nasal symptoms caused by seasonal and perennial allergic rhinitis. These symptoms can include congestion, sneezing, itching, and runny nose. It is also used to manage symptoms of non-allergic rhinitis, such as nasal congestion and postnasal drip.

Pharmacokinetics

Flonase exhibits a low systemic bioavailability when administered intranasally, with less than 2% of the active substance reaching the systemic circulation. This is due to the extensive first-pass metabolism in the liver and the gut. The elimination half-life of fluticasone propionate is approximately 7.8 hours.

Onset of Action

Flonase typically begins to work within 12 hours of the first dose, but it may take several days of regular use to achieve its full therapeutic effect. Patients are advised to continue regular use for optimal symptom control and not to expect immediate symptom relief.

Pediatric Use

For children aged 4-11 years, Flonase should be administered under adult supervision. The dosage is generally lower, with one spray per nostril once daily. The safety and efficacy of Flonase for children under the age of 4 have not been established.

Geriatric Use

Clinical studies on Flonase have not included sufficient numbers of patients aged 65 and older to determine if they respond differently from younger patients. However, no overall differences in safety or effectiveness have been observed between elderly and younger patients.

Drug Interactions

Flonase may interact with other corticosteroids or medications that affect corticosteroid metabolism. Strong cytochrome P450 3A4 inhibitors, such as ritonavir, can significantly increase plasma concentrations of fluticasone propionate, potentially leading to systemic corticosteroid side effects.

Alcohol Interaction

There is no known significant interaction between Flonase and alcohol. However, patients should consult their healthcare provider for personalized advice regarding alcohol consumption while using Flonase.

Side Effects

Common side effects of Flonase include nasal irritation, dryness, and a burning sensation. Other side effects may include headaches, nosebleeds, and an altered sense of taste or smell. In rare cases, more severe side effects like nasal septal perforation and cataracts may occur.

Rare Side Effects

Rare but serious side effects include hypersensitivity reactions such as anaphylaxis, visual disturbances, glaucoma, and immunosuppression, which may increase the risk of infections. Patients should report any unexpected reactions to their healthcare provider.

Storage Conditions

Flonase should be stored at room temperature, between 15-30 degrees Celsius (59-86 degrees Fahrenheit). It should be kept away from moisture and direct sunlight, and out of reach of children and pets. Do not freeze or refrigerate the nasal spray.

Special Populations

Special consideration should be given to patients with hepatic impairment, as fluticasone propionate undergoes extensive first-pass metabolism in the liver. In these patients, systemic exposure to the drug may be increased, requiring dose adjustments and close monitoring.

Administration Techniques

Patients should blow their noses to clear nasal passages before administering Flonase. The bottle should be shaken gently, and the spray nozzle inserted into one nostril while closing the other nostril. The patient should tilt their head forward slightly and breathe in gently while spraying. This should be repeated for the other nostril.

Missed Dose Instructions

If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for the missed one.

Patient Counseling Information

Patients should be informed about the need for regular use to achieve and maintain symptom control. They should also be advised on the correct administration technique and the importance of not exceeding the recommended dosage. Potential side effects and the importance of reporting any adverse reactions should also be discussed.