Fluticasone Nasal Spray Dosage and Treatment Duration for Allergic Rhinitis
For allergic rhinitis, fluticasone propionate nasal spray should be administered at a dosage of 2 sprays per nostril (200 mcg total) once daily for adults, and 1 spray per nostril (100 mcg total) once daily for children ages 4-11 years. 1, 2
Age-Specific Dosing Recommendations
Adults and Adolescents (≥12 years)
- Initial dosage: 2 sprays per nostril (200 mcg total) once daily 1, 2
- Alternative regimen: 1 spray per nostril (100 mcg total) twice daily 2
- Once adequate control is achieved, some patients may be maintained on 1 spray per nostril (100 mcg total) once daily 2
Children (4-11 years)
- Initial dosage: 1 spray per nostril (100 mcg total) once daily 1, 2, 3
- For inadequate response: May increase to 2 sprays per nostril (200 mcg total) once daily 2
- Once adequate control is achieved, decrease to 1 spray per nostril (100 mcg total) once daily 2
Children (2-3 years)
- Not FDA approved for this age group for fluticasone propionate 1
- Note: Fluticasone furoate (Veramyst) is approved for ages ≥2 years at 1-2 sprays per nostril daily 1
Treatment Duration
- For seasonal allergic rhinitis: Treatment should begin before allergen exposure when possible and continue throughout the allergy season 2
- For perennial allergic rhinitis: Regular daily use provides optimal benefit 2, 4
- Long-term safety has been demonstrated in studies lasting up to 6 months 4
Clinical Pearls
- Onset of action: Symptom improvement may begin within 12 hours, but maximum effect may take several days 2
- Once-daily morning dosing is as effective as twice-daily dosing, which may improve adherence 4, 5
- "As-needed" use (not exceeding 200 mcg daily) may be effective for some patients with seasonal allergic rhinitis aged ≥12 years, but scheduled regular use provides greater symptom control 2
- Efficacy is due to direct topical effects rather than systemic effects 6
Common Side Effects
- Headache, pharyngitis, epistaxis (nose bleeds) 1
- Nasal burning or irritation, nausea or vomiting 1
- Asthma symptoms, cough 1
Important Considerations
- Contraindicated in patients with history of hypersensitivity to fluticasone or its components 1
- No evidence that exceeding the recommended dose provides additional benefit 2
- At recommended doses, fluticasone has minimal systemic activity and a favorable risk-benefit ratio 7
- For children, the 100 mcg daily dose is as effective as 200 mcg daily and minimizes potential systemic effects 3