From the Guidelines
When starting aerosol flunisolide therapy, patients should be advised to rinse their mouth thoroughly with water after each use and then spit the water out to prevent oral candidiasis, a common side effect of inhaled corticosteroids like flunisolide 1. This recommendation is based on the understanding that inhaled corticosteroids (ICSs) like flunisolide are a cornerstone of therapy for patients with persistent asthma, as outlined in the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma 1.
Key Points for Patient Education
- The full therapeutic effect of flunisolide may take 1-2 weeks to develop, so patients should use it regularly as prescribed even if they don't notice immediate improvement.
- Proper inhaler technique is crucial to ensure optimal drug delivery to the lungs.
- Flunisolide is a controller medication for conditions like asthma, not a rescue medication for acute symptoms.
- If using other inhaled medications, patients should use bronchodilators before flunisolide to help open airways and enhance corticosteroid deposition.
- Patients should report any persistent oral irritation, hoarseness, or unusual symptoms to their healthcare provider.
Importance of Adherence and Monitoring
Regular use of flunisolide as prescribed, along with proper technique and adherence to other treatment recommendations, can help manage asthma symptoms effectively and improve quality of life 1.
Considerations for Safe Use
Given the potential for side effects and the importance of proper use, patient education and monitoring by a healthcare provider are critical components of flunisolide therapy 1.
From the FDA Drug Label
Adults: The recommended starting dose of flunisolide nasal solution is 2 sprays (50 mcg) in each nostril 2 times a day (total dose 200 mcg/day). Pediatric Patients 6 to 14 years: The recommended starting dose of flunisolide nasal solution is 1 spray (25 mcg) in each nostril 3 times a day or 2 sprays (50 mcg) in each nostril 2 times a day (total dose 150 to 200 mcg/day)
The patient should be advised to start with the recommended dose:
- For adults: 2 sprays (50 mcg) in each nostril 2 times a day (total dose 200 mcg/day)
- For pediatric patients 6 to 14 years: 1 spray (25 mcg) in each nostril 3 times a day or 2 sprays (50 mcg) in each nostril 2 times a day (total dose 150 to 200 mcg/day) 2 Key points to consider:
- The dose may be increased if needed, but the maximum total daily doses should not be exceeded.
- The maintenance dose should be reduced to the smallest amount necessary to control the symptoms after the desired clinical effect is obtained.
From the Research
Recommendations for Aerosol Flunisolide Therapy
When starting aerosol flunisolide therapy, patients should be informed of the following:
- The typical dosage of flunisolide aerosol is 0.5 mg (two inhalations) twice daily 3, 4.
- Patients should be monitored for symptom assessment, physical examination, and pulmonary function testing every two weeks 3.
- Adrenal function tests should be done initially and at the conclusion of the study 3.
- Patients should be aware that flunisolide aerosol can help reduce oral steroid requirements without apparent adverse effects 3, 5.
- The efficacy and safety of flunisolide aerosol have been demonstrated in steroid-dependent and steroid-independent children and adults with asthma 3, 4, 5, 6.
- Patients should be informed that flunisolide may cause less suppression of the hypothalamic-pituitary-adrenal (HPA) axis compared to other inhaled corticosteroids, such as fluticasone propionate 7.
- Patients should be instructed to use the inhaler correctly and to report any side effects or concerns to their healthcare provider.
- Regular follow-up appointments should be scheduled to monitor the patient's response to therapy and adjust the dosage as needed.