Fluticasone propionate nasal spray is used for symptomatic treatment of seasonal or perennial allergic rhinitis and also for perennial nonallergic rhinitis.
Fluticasone propionate nasal spray is used for the symptomatic treatment of seasonal or perennial allergic rhinitis.
In patients with seasonal or perennial allergic rhinitis, intranasal administration of fluticasone propionate generally provides symptomatic relief of watery rhinorrhea, nasal congestion, sneezing, postnasal drip, and nasal itching. Although intranasal fluticasone propionate generally does not relieve manifestations of conjunctivitis, improvement in ophthalmic manifestations has occurred in some patients receiving the drug intranasally. Since fluticasone propionate is thought to exert a local effect on the nasal mucosa, the mechanism for these ophthalmic effects is not fully understood. Improvement in ophthalmic manifestations may be caused partly by a decrease in the nasolacrimal reflex, which occurs as symptoms of rhinitis improve. It also has been suggested that decreased edema of the nasal mucosa may promote better drainage of tears through the lacrimal ducts.
Evidence from a limited number of studies in children 4-11 years of age suggests that intranasal fluticasone propionate 100-200 mcg daily is more effective than placebo in relieving symptoms of seasonal allergic rhinitis and is not associated with unusual adverse effects compared with those observed in adults receiving the drug; however, in one study in children, improvement in nasal symptoms with intranasal fluticasone propionate therapy was less pronounced than that generally reported in adults.
Intranasal fluticasone propionate (200 mcg daily given in 1 or 2 divided doses in adults and adolescents) appears to be at least as effective as intranasal beclomethasone dipropionate (168 mcg twice daily) in the treatment of seasonal or perennial allergic rhinitis; preliminary data also suggest efficacy comparable to that of usual dosages of intranasal flunisolide acetonide. In children 6-11 years of age with perennial allergic rhinitis, intranasal fluticasone propionate (100 mcg once or twice daily) was as effective as intranasal beclomethasone dipropionate (168 mcg twice daily). In a limited number of studies, fluticasone propionate generally was more effective in relieving nasal symptoms in adults and adolescents than the oral antihistamines terfenadine (no longer commercially available in the US), astemizole (no longer commercially available in the US), cetirizine, or loratadine or the mast-cell inhibitor cromolyn sodium. However, in a randomized, controlled study in patients with seasonal allergic rhinitis, addition of oral cetirizine (10 mg once daily) to the usual dosage of fluticasone propionate (200 mcg once daily) did not improve control of nasal and ocular symptoms compared with fluticasone propionate therapy alone. Whether the very low oral bioavailability of intranasal fluticasone propionate
(see Pharmacokinetics)will be associated with a reduced risk of systemic adverse effects compared with other currently available intranasal corticosteroids remains to be established. Current evidence suggests that 200 mcg of fluticasone propionate given once daily is as effective as 100 mcg of the drug given twice daily.
In several dose-response studies in pediatric patients, once-daily administration of 100 mcg of fluticasone propionate appeared to be as effective as 200 mcg once daily; however, pediatric patients with more severe symptoms of allergic rhinitis benefited from the higher recommended dosage (200 mcg daily).
In 2 double-blind, placebo (vehicle)-controlled, short-term (28-day) trials in patients 12 years of age and older with seasonal allergic rhinitis, patients using fluticasone (up to 200 mcg [2 sprays in each nostril] once daily) on an as-needed basis experienced a greater reduction in symptoms (nasal congestion, rhinorrhea, sneezing, and nasal pruritus) than patients receiving placebo. Study medication was used an average of 57-70% of study days for all treatment groups; the relative difference in efficacy with as-needed use compared with regularly scheduled use of fluticasone was not studied. Efficacy of as-needed fluticasone has not been studied in patients younger than 12 years of age with seasonal allergic rhinitis or in patients with perennial allergic or nonallergic rhinitis.
In patients with seasonal or perennial allergic rhinitis, symptomatic relief usually is evident within 12-48 hours of continuous intranasal fluticasone propionate therapy; however, up to 2-4 days may be required for optimum effectiveness in some patients. Supplemental therapy with oral antihistamines and/or topical nasal decongestants may be necessary until an acceptable clinical response is achieved. In some patients, ophthalmic preparations may be necessary to relieve manifestations of conjunctivitis not controlled by intranasal corticosteroids. Although ophthalmic preparations containing vasoconstrictors and antihistamines or corticosteroids may be effective in relieving ophthalmic inflammatory symptoms in patients with rhinitis, concurrent use of ophthalmic and intranasal corticosteroids generally is not recommended since the risk of adverse ophthalmic effects associated with corticosteroid therapy (e.g., glaucoma, cataract formation, exacerbation of ophthalmic infections) may be increased. In some patients with seasonal or perennial rhinitis, especially those with concurrent asthmatic conditions, continuous concomitant therapies (e.g., oral or orally inhaled corticosteroids, bronchodilators, antihistamines, decongestants) may be required for optimum symptomatic relief; concomitant therapy with intranasal and other systemic corticosteroids may increase the risk of hypercorticism and/or HPA-axis suppression.
(See Cautions: Precautions and Contraindications.)
Fluticasone propionate nasal spray is used for the symptomatic treatment of perennial nonallergic rhinitis. Evidence from the majority of placebo (vehicle)-controlled studies in patients with nonallergic rhinitis indicates that intranasal administration of fluticasone propionate is associated with lower total nasal symptom scores (nasal obstruction, postnasal drip, rhinorrhea) than administration of vehicle.
Fluticasone propionate has been used successfully prior to the onset of the pollen season for the prophylaxis of symptoms of seasonal allergic rhinitis. In a comparative study, fluticasone propionate (200 mcg once daily) appeared to be more effective than cromolyn sodium (5.2 mg 4 times daily) in preventing nasal symptoms (e.g., sneezing, rhinorrhea, nasal congestion or itching) when the drugs were initiated at least 1 week prior to the anticipated start of the grass pollen season in patients with seasonal allergic rhinitis; both treatments were well tolerated. Fluticasone propionate has been used successfully by oral inhalation in the management of asthma in patients whose symptoms were not controlled by occasional use of bronchodilators.