What are the proper dispensing instructions for Flonase (fluticasone propionate)?

Proper Dispensing Instructions for Flonase (Fluticasone Propionate)

For optimal therapeutic benefit, Flonase (fluticasone propionate) nasal spray should be administered as 2 sprays (50 mcg per spray) in each nostril once daily (total daily dose 200 mcg) for adults, and 1 spray in each nostril once daily (total daily dose 100 mcg) for children 4 years and older. 1

Dosage Instructions by Age Group

Adults and Adolescents (12 years and older):

• Initial dosage: 2 sprays in each nostril once daily (200 mcg total daily dose)
• Alternative dosing: The same total daily dose (200 mcg) can be divided into 1 spray in each nostril twice daily
• Maintenance dosage: After the first few days, some patients may be able to reduce to 1 spray in each nostril once daily (100 mcg total) for maintenance therapy 1

Children (4-11 years):

• Starting dosage: 1 spray in each nostril once daily (100 mcg total)
• For inadequate response: May increase to 2 sprays in each nostril once daily (200 mcg total)
• Maintenance dosage: Once adequate control is achieved, decrease to 1 spray in each nostril daily 1
• Maximum daily dosage: Should not exceed 2 sprays in each nostril (200 mcg/day) 1

Not Recommended:

• Not recommended for children under 4 years of age 1

Administration Instructions

1. Preparation:

   • Shake the bottle gently before each use 2, 1
   • Prime the pump before first use by pressing down and releasing 6 times with the nasal applicator pointing away from you 1
   • If not used for 7 days or more, re-prime until a fine spray appears 1

2. Proper Technique:

   • Blow nose to clear nostrils before use 2, 1
   • Keep head in an upright position 2
   • Hold the spray in the opposite hand in relation to the nostril being treated (contralateral technique) to aim spray away from septum 2
   • Close one nostril
   • Insert the nasal applicator into the other nostril while keeping the bottle upright 1
   • Breathe in gently or slowly during spraying 2
   • Do not close the opposite nostril to prevent pushing the septum to the side of the spray 2

3. Follow-up Care:

   • If using nasal saline irrigations, perform them prior to using Flonase to avoid rinsing out the medication 2

Timing and Consistency

• Use at regular intervals for optimal effect 1
• Best results are obtained with regular, consistent use 1
• May begin to work within 12 hours of first dose, but takes several days of regular use to reach maximum effectiveness 1

Special Considerations

• If a dose is missed, take the next regularly scheduled dose (do not double the dose) 1
• For patients with physical limitations (arthritis, Parkinson's disease), special attention may be needed to ensure proper administration technique 2
• Patients should be advised that Flonase helps reduce symptoms of allergic reactions including stuffiness, runniness, itching, and sneezing 1

Common Side Effects to Mention

• Headache, pharyngitis, epistaxis (nosebleeds), nasal burning or irritation 2
• Cough, nausea or vomiting, asthma symptoms 2

Dispensing Pearls

1. Technique Demonstration:

   • Pharmacists should demonstrate proper spray technique using a placebo device when dispensing 2
   • Teaching proper administration technique improves efficacy, reduces side effects, and enhances adherence 2

2. Patient Education:

   • Emphasize that consistent daily use is more effective than as-needed use 1
   • Explain that full therapeutic effect may take several days of regular use 1
   • Advise patients to continue use as prescribed even after symptoms improve 1

3. Refill Considerations:

   • "Dispense as written" requests may lead to decreased rates of prescription filling due to higher costs 3
   • Consider discussing generic options if cost is a concern

By following these dispensing instructions, patients will maximize the therapeutic benefits of Flonase while minimizing potential side effects.