Is it safe to take 2 sprays of Flonase (fluticasone) daily in each nostril?

Safety of Using 2 Sprays of Flonase Daily

Yes, it is safe and FDA-approved to take 2 sprays of Flonase (fluticasone) in each nostril once daily for adults with allergic rhinitis. 1

Recommended Dosing for Fluticasone Nasal Spray

For Adults:

• The FDA-approved starting dosage is 2 sprays (50 mcg of fluticasone propionate each) in each nostril once daily (total daily dose of 200 mcg) 1
• Alternatively, the same total dosage can be divided into 100 mcg given twice daily (morning and evening) 1
• After the first few days, some adults may be able to reduce their dosage to 1 spray in each nostril once daily (100 mcg total) for maintenance therapy 1

For Children and Adolescents (4 years and older):

• Starting dose is 1 spray in each nostril once daily (100 mcg total) 1
• If not adequately responding, may increase to 2 sprays in each nostril once daily (200 mcg total) 2
• Once symptoms are controlled, dosage should be decreased to 1 spray in each nostril daily 1

Efficacy and Safety Considerations

Efficacy:

• Intranasal corticosteroids like fluticasone are considered the most effective single medication class for controlling all symptoms of allergic rhinitis 3
• Fluticasone effectively controls the four major symptoms of allergic rhinitis: sneezing, itching, rhinorrhea, and nasal congestion 3
• Once-daily dosing of fluticasone has been shown to be as effective as twice-daily dosing in multiple studies 4, 5

Safety Profile:

• The most common side effects of fluticasone nasal spray are mild and include:
  • Epistaxis (nosebleeds)
  • Pharyngitis
  • Nasal burning or irritation
  • Headache 2, 3
• When used at recommended doses, fluticasone has a favorable safety profile with minimal systemic absorption 3
• The safety profile of fluticasone is similar to placebo in clinical trials 5

Important Usage Instructions

1. Proper Technique:

   • Shake the bottle gently before each use
   • Prime the pump before first use (6 sprays into the air) or if not used for 7+ days
   • Blow your nose to clear nostrils before administration
   • Tilt head slightly forward when spraying
   • Spray away from the nasal septum (middle of nose) 1

2. Duration of Effect:

   • May begin to work within 12 hours of first dose
   • Full therapeutic effect may take several days of regular use 1
   • For seasonal allergic rhinitis, some patients may benefit from as-needed use rather than daily use 6

3. Maintenance Therapy:

   • After initial symptom control, many adults can reduce to 1 spray in each nostril daily 1
   • Regular use provides better symptom control than as-needed use for most patients 6

Cautions and Contraindications

• Contraindicated in patients with hypersensitivity to fluticasone or components of the formulation 2
• Use with caution in patients with recent nasal surgery, trauma, or ulceration
• Not recommended for children under 4 years of age 1
• Should not be used in the presence of untreated localized infection of the nasal mucosa

Conclusion

The 2 sprays per nostril once daily dosing of Flonase is safe, effective, and FDA-approved for adults with allergic rhinitis. This dosing regimen has been extensively studied and shown to provide effective symptom relief with a favorable safety profile. After initial symptom control, consider reducing to a maintenance dose of 1 spray per nostril daily.