Flonase (Fluticasone Propionate) Dosing Recommendations
The recommended dosing for Flonase (fluticasone propionate) nasal spray is 2 sprays (50 mcg each) in each nostril once daily (200 mcg total daily dose) for adults, while children aged 4 years and older should start with 1 spray in each nostril once daily (100 mcg total). 1
Adult Dosing
- Initial dose: 2 sprays (50 mcg each) in each nostril once daily (200 mcg total daily dose)
- Alternative dosing: The same total daily dose (200 mcg) can be divided into 100 mcg given twice daily (morning and evening)
- Maintenance dose: After the first few days, many adults can reduce to 1 spray in each nostril once daily (100 mcg total) for maintenance therapy 1
- As-needed use: Some patients (12 years and older) with seasonal allergic rhinitis may find as-needed use of 200 mcg once daily effective, though greater symptom control is typically achieved with scheduled regular use 1
Pediatric Dosing
- Children 4-11 years:
- Adolescents (12+ years): Same dosing as adults 1
- Children under 4 years: Not recommended 1
Administration Guidance
- For optimal effect, use at regular intervals 1
- Morning dosing is as effective as twice-daily dosing, which may improve compliance 3, 4
- Ensure patent nasal airway before administration 5
- If severe congestion is present, consider short-term decongestant use (3-5 days maximum) before starting fluticasone 5
- Proper technique is essential to ensure medication reaches target areas 5
Efficacy Considerations
- Fluticasone propionate is considered one of the most effective medications for controlling all symptoms of allergic rhinitis 5
- Onset of action typically begins within 7 days, with significant symptom reduction 3
- Allow 4-6 weeks of consistent use before determining treatment failure 5
- Once-daily dosing has been shown to be as effective as twice-daily dosing in clinical trials 3, 6, 4
Safety Profile
- Common adverse events include epistaxis, pharyngitis, nasal irritation, and headache, which are typically mild and transient 5
- No evidence of hypothalamic-pituitary-adrenal axis suppression at recommended doses 2, 7
- Fluticasone propionate has rapid clearance to an inactive metabolite, contributing to its favorable safety profile 7
Special Populations
- Children: Growth concerns should be considered, though studies in children 4-11 years showed no significant impact on morning plasma cortisol levels 5, 2
- Pregnant patients: Generally has good safety profile, but individual risk-benefit assessment is needed 5
Remember that proper technique and consistent use are essential for optimal symptom control. The maximum total daily dosage should not exceed 2 sprays in each nostril (200 mcg/day).