Recommended Dosage of Flonase (Fluticasone Propionate) for Allergic Rhinitis
For adults with allergic rhinitis, the recommended dose of Flonase (fluticasone propionate) is 2 sprays per nostril once daily (total 200 mcg/day). 1
Age-Based Dosing Guidelines
Adults (≥18 years):
- Standard dose: 2 sprays per nostril once daily (200 mcg/day) 1, 2
- Alternative regimen: 1 spray per nostril twice daily (200 mcg/day) 2
- Once adequate symptom control is achieved, may reduce to 1 spray per nostril once daily (100 mcg/day) for maintenance 2
Children and Adolescents:
- Ages 4-11 years: 1 spray per nostril once daily (100 mcg/day) 1, 3
- Ages 12-17 years: 2 sprays per nostril once daily (200 mcg/day) 1, 3
- For children not adequately responding to 100 mcg daily, may increase to 2 sprays per nostril once daily or 1 spray per nostril twice daily (200 mcg/day) 2
Administration Recommendations
- Direct spray away from the nasal septum to prevent irritation 3
- For optimal delivery, keep head upright during administration 3
- Use right hand to spray left nostril and vice versa 3
- Regular use provides better symptom control than as-needed use 2
Efficacy Considerations
- Onset of action can be as soon as 12 hours after initial dose, but maximum effect may take several days 2
- Once-daily dosing (200 mcg) is as effective as twice-daily dosing (100 mcg twice daily) 2, 4
- Fluticasone propionate at 100 mcg/day has been shown to be effective in children as young as 4 years 5
Safety Considerations
- Common side effects include headache, pharyngitis, epistaxis, nasal burning/irritation, nausea/vomiting, asthma symptoms, and cough 1
- Examine the nasal septum periodically when using corticosteroid sprays to check for mucosal erosions 3
- Fluticasone has minimal systemic activity as the swallowed portion is not absorbed from the gut 6
- The risk-benefit ratio at recommended doses is very favorable 6
Important Caveats
- Do not exceed 2 sprays per nostril daily (total 200 mcg/day) in adults or children 2
- Irregular use reduces effectiveness 3
- For seasonal allergic rhinitis, as-needed use (not exceeding 2 sprays per nostril once daily) may be effective in patients 12 years and older 2
- As-needed use has not been studied in children under 12 years or in perennial allergic rhinitis 2
Fluticasone propionate is effective for both seasonal and perennial allergic rhinitis, as well as non-allergic rhinitis, with a favorable safety profile when used as directed.