What is the use of Flonase (fluticasone propionate)?

From the Guidelines

Flonase (fluticasone propionate) is an effective nasal steroid spray used to treat allergic rhinitis symptoms like nasal congestion, sneezing, and runny nose, with a standard adult dose of 1-2 sprays in each nostril once daily, as recommended by the 2017 joint task force on practice parameters 1. The dose for children 4-11 years old is 1 spray per nostril daily, as indicated in the clinical practice guideline for allergic rhinitis 1. For best results, use Flonase consistently every day, as it may take several days to reach full effectiveness. Before first use, prime the bottle by spraying 6 times away from your face. To use properly, shake the bottle gently, tilt your head slightly forward, insert the tip into your nostril pointing toward the outer eye, and spray while breathing in gently. Flonase works by reducing inflammation in the nasal passages, blocking chemicals that trigger allergic reactions. Some key points to consider when using Flonase include:

• Side effects may include nasal irritation, headache, and nosebleeds.
• If you're pregnant, breastfeeding, or have glaucoma, consult your doctor before using.
• Unlike decongestant sprays, Flonase can be used long-term without rebound congestion. It's also important to note that combination therapy with an intranasal antihistamine and an intranasal corticosteroid, such as fluticasone propionate plus azelastine, may provide greater symptom reduction than monotherapy with either agent alone, as shown in several studies 1. However, the choice of treatment should be individualized based on the patient's specific needs and medical history. In general, the use of Flonase as a single agent or in combination with an intranasal antihistamine is a reasonable treatment option for patients with allergic rhinitis, as supported by the available evidence 1.

From the FDA Drug Label

INDICATIONS AND USAGE Fluticasone Propionate Nasal Spray, USP, is indicated for the management of the nasal symptoms of seasonal and perennial allergic and nonallergic rhinitis in adults and pediatric patients 4 years of age and older. CLINICAL TRIALS A total of 13 randomized, double-blind, parallel-group, multicenter, vehicle placebo-controlled clinical trials were conducted in the United States in adults and pediatric patients (4 years of age and older) to investigate regular use of Fluticasone Propionate Nasal Spray, USP, in patients with seasonal or perennial allergic rhinitis

The main use of Flonase is for the management of nasal symptoms of:

• Seasonal allergic rhinitis
• Perennial allergic rhinitis
• Nonallergic rhinitis in adults and pediatric patients 4 years of age and older 2 2.

From the Research

Flonase Overview

• Flonase, also known as fluticasone, is a type of intranasal corticosteroid used to treat allergic rhinitis 3.
• It is available by prescription and is used to relieve symptoms such as nasal congestion, itching, rhinorrhea, and sneezing 3.

Efficacy of Flonase

• Studies have shown that Flonase is effective in treating perennial allergic rhinitis, with significant improvements in nasal symptom scores and quality of life 4.
• A randomized controlled trial found that both as-needed and regular use of Flonase had similar improvements in total nasal symptom scores and Rhinoconjunctivitis Quality of Life-36 Questionnaire scores 4.
• Another study found that intranasal corticosteroids, including Flonase, are efficacious in treating seasonal allergic rhinitis and as prophylaxis for perennial allergic rhinitis 3.

Safety of Flonase

• The safety of Flonase has been evaluated in several studies, with no significant topical or systemic complications observed 5.
• A review of published literature on the safety of intranasal corticosteroids found that the newer formulations, such as fluticasone furoate, may be safer for long-term use due to their lower systemic bioavailability 5.
• However, another study found that long-term use of inhaled corticosteroids, including fluticasone propionate, may be associated with an increased risk of cataracts and glaucoma, although this was not observed in a specific study of COPD patients 6.

Treatment Guidelines

• The treatment of allergic rhinitis typically involves avoiding inciting allergens and using medications such as second-generation H1 antihistamines, intranasal antihistamines, and intranasal corticosteroids like Flonase 7.
• The choice of treatment depends on the severity and frequency of symptoms, as well as patient preference 7.