From the Guidelines
Yes, Claritin (loratadine) and Flonase (fluticasone) can be safely prescribed together for allergic rhinitis, and this combination is often more effective than either medication alone. According to the most recent and highest quality study, a 2017 guideline from the Joint Task Force on Practice Parameters 1, the combination of an intranasal corticosteroid and an oral antihistamine may be recommended for initial treatment of moderate to severe seasonal allergic rhinitis. Claritin is a second-generation antihistamine that blocks histamine receptors systemically, reducing sneezing, itching, and runny nose, while Flonase is a nasal corticosteroid spray that reduces local inflammation in the nasal passages. The typical adult dose for Claritin is 10 mg once daily, and for Flonase, it's 1-2 sprays in each nostril once daily (50-100 mcg per nostril). These medications work through different mechanisms, making them complementary. Claritin provides quick relief of symptoms while Flonase, which may take several days to reach full effectiveness, provides longer-term control of nasal inflammation. This combination is particularly useful for patients with moderate to severe allergic rhinitis or those who don't achieve adequate symptom control with a single medication. Side effects are generally minimal, with Claritin occasionally causing mild drowsiness and Flonase sometimes causing nasal irritation or minor nosebleeds.
Some key points to consider when prescribing this combination include:
- The patient's severity of symptoms and response to initial treatment
- The potential for additive benefits of combining an intranasal corticosteroid and an oral antihistamine
- The importance of monitoring for potential side effects and adjusting the treatment plan as needed
- The consideration of alternative treatment options, such as allergen immunotherapy, for patients with moderate to severe seasonal allergic rhinitis.
It's also important to note that the 2017 guideline from the Joint Task Force on Practice Parameters 1 recommends monotherapy with an intranasal corticosteroid as the initial treatment for seasonal allergic rhinitis in persons aged 12 years or older, rather than combination therapy with an intranasal corticosteroid and an oral antihistamine. However, the combination of Claritin and Flonase may be considered for patients with moderate to severe symptoms or those who do not respond to monotherapy.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Combination Therapy for Allergic Rhinitis
The question of whether Claritin (loratadine) and Flonase (fluticasone) can be prescribed together for allergic rhinitis can be addressed by examining the efficacy and safety of combination therapy with an oral antihistamine and an intranasal corticosteroid.
- Studies have shown that combination therapy with an oral antihistamine and an intranasal corticosteroid can be effective in treating allergic rhinitis, although the benefits over monotherapy with an intranasal corticosteroid may be limited 2, 3, 4.
- A study comparing the efficacy of fluticasone propionate aqueous nasal spray and loratadine, alone and in combination, found that the combination therapy was comparable in efficacy to fluticasone propionate monotherapy, and both were more effective than loratadine alone 4.
- Another study found that combination therapy with mometasone furoate nasal spray and loratadine provided benefits similar to monotherapy with mometasone furoate nasal spray for the symptoms of seasonal allergic rhinitis 3.
- The safety profile of combination therapy with an oral antihistamine and an intranasal corticosteroid has been found to be similar to that of monotherapy with an intranasal corticosteroid, with no significant increase in adverse events 3, 4.
Efficacy of Combination Therapy
The efficacy of combination therapy with Claritin and Flonase can be inferred from studies examining the combination of an oral antihistamine and an intranasal corticosteroid.
- A review of clinical trials found that combination therapy with fluticasone propionate and an oral antihistamine, such as loratadine, had efficacy comparable to that of intranasal corticosteroid alone 2.
- A study comparing azelastine nasal spray monotherapy with combination therapy with loratadine and beclomethasone found that the combination therapy was as effective as azelastine nasal spray monotherapy in treating moderate-to-severe symptoms of seasonal allergic rhinitis 5.
Safety and Tolerability
The safety and tolerability of combination therapy with Claritin and Flonase have been found to be similar to those of monotherapy with an intranasal corticosteroid.
- Studies have reported that the most common adverse events associated with combination therapy are similar to those associated with monotherapy, with no significant increase in adverse events 3, 4.
- The safety profile of loratadine has been found to be similar to that of placebo, with the most common adverse events being headache and somnolence 6.