Is Flonase (fluticasone) nasal spray safe to use during pregnancy?

Fluticasone Nasal Spray Safety During Pregnancy

Fluticasone nasal spray (Flonase) is safe to use during pregnancy at recommended doses and can be continued throughout pregnancy for rhinitis or chronic rhinosinusitis management. 1

Evidence for Safety

Intranasal corticosteroids, including fluticasone, have been evaluated for safety during pregnancy:

• The only placebo-controlled randomized study specifically examining fluticasone nasal spray in pregnancy showed no detectable influence on maternal cortisol levels, fetal growth, or pregnancy outcomes 1
• Expert panel recommendations from rhinology guidelines state that modern nasal corticosteroids including fluticasone should be safe to use during pregnancy at recommended doses 1
• There is no significant association between fluticasone propionate nasal spray use and congenital organ malformations 2

Pharmacological Considerations

Fluticasone has favorable pharmacological properties that contribute to its safety profile:

• Minimal systemic absorption when used as directed
• No evidence of teratogenicity in animal studies at doses higher than recommended human doses 3
• FDA pregnancy category C classification, which indicates that risk cannot be ruled out but potential benefits may justify use 3

Clinical Recommendations

First-line approach:

• Continue fluticasone nasal spray at the lowest effective dose to control symptoms
• Use standard recommended dosing:
  • Adults: 2 sprays in each nostril once daily
  • Children (4 years and older): 1 spray in each nostril once daily 3

Important precautions:

• Avoid exceeding recommended doses
• Do not use off-label formulations such as fluticasone nasal drops or irrigations 1
• If using other medications, be aware that ritonavir and ketoconazole can increase systemic absorption of fluticasone 3

Common Pitfalls to Avoid

1. Discontinuing effective treatment: Untreated nasal symptoms can negatively impact maternal quality of life and potentially sleep quality, which may have indirect effects on pregnancy outcomes.

2. Switching to oral decongestants: These should be avoided during pregnancy as they carry greater risks than intranasal corticosteroids 1, 4.

3. Using first-generation antihistamines: These have sedative and anticholinergic properties that make them less desirable than intranasal corticosteroids during pregnancy 1.

4. Confusing safety profiles: Not all intranasal corticosteroids have the same safety data in pregnancy. For example, intranasal triamcinolone has been associated with respiratory tract defects, while fluticasone has not shown such associations 2.

Fluticasone nasal spray represents a reasonable balance between symptom control and safety during pregnancy when used as directed. The benefits of treating nasal symptoms typically outweigh the theoretical risks of appropriate intranasal corticosteroid use.