From the FDA Drug Label
Fluticasone Propionate Nasal Spray, USP is an effective, allergy medicine that you can buy without a prescription. It works directly in the nose to help block your allergic reactions. Mometasone Furoate Nasal Spray, 50 mcg Per Spray Allergy Symptom Reliever (Glucocorticoid)*
The FDA drug label does not answer the question.
From the Research
Intranasal fluticasone propionate is the recommended nasal steroid for treating rhinitis medicamentosa. The typical regimen involves using 1-2 sprays in each nostril once or twice daily for 2-4 weeks while simultaneously discontinuing the overused decongestant nasal spray that caused the condition. Fluticasone is preferred because it has minimal systemic absorption, good local anti-inflammatory effects, and helps reduce the rebound congestion that occurs when stopping the offending decongestant, as shown in studies such as 1. Other nasal steroids like mometasone furoate or budesonide can also be effective alternatives.
During treatment, patients should expect initial worsening of congestion for 3-7 days before improvement begins. Using saline nasal irrigation and oral antihistamines can help manage symptoms during this transition period. The underlying mechanism involves the nasal steroid reducing the inflammation caused by chronic vasoconstrictor use while allowing the nasal mucosa to heal and restore normal function. According to 2, fluticasone propionate has demonstrated potent local anti-inflammatory activity and little, if any, systemic activity, making it a safe and effective option for treating rhinitis medicamentosa.
Some key points to consider when treating rhinitis medicamentosa with intranasal fluticasone propionate include:
- Starting with a dose of 1-2 sprays in each nostril once or twice daily
- Simultaneously discontinuing the overused decongestant nasal spray
- Expecting initial worsening of congestion before improvement begins
- Using saline nasal irrigation and oral antihistamines to manage symptoms during the transition period
- Monitoring for potential adverse effects, such as nasal dryness or bleeding, although these are rare, as noted in 3 and 4.
Overall, intranasal fluticasone propionate is a convenient, effective, and well-tolerated alternative to other intranasal corticosteroids and antihistamines for the treatment of rhinitis medicamentosa, as supported by studies such as 5.