Can you take fluticasone (fluticone) spray plus oral antihistamines?

Fluticasone Nasal Spray with Oral Antihistamines for Allergic Rhinitis

Yes, you can safely take fluticasone nasal spray plus oral antihistamines together, and this combination may provide better symptom relief for some patients with allergic rhinitis than either medication alone. 1

Efficacy of Combination Therapy

• Intranasal corticosteroids like fluticasone are the most effective single medication class for controlling the four major symptoms of allergic rhinitis: sneezing, itching, rhinorrhea, and nasal congestion 1, 2
• While intranasal corticosteroids are generally more effective than oral antihistamines alone, some patients may benefit from combination therapy 1
• In one well-controlled study of seasonal allergic rhinitis, the addition of cetirizine (an oral antihistamine) to intranasal fluticasone propionate led to greater relief of pruritus (itching) 1
• Another study found that the combination of fluticasone propionate and loratadine was superior to fluticasone propionate alone for some patient-rated symptoms 1
• At least one study found that approximately 50% of patients need both intranasal corticosteroids and oral antihistamines to adequately control symptoms of seasonal allergic rhinitis 1

Treatment Algorithm

• For initial treatment of non-severe allergic rhinitis:

  • Start with either an intranasal corticosteroid (like fluticasone) or an oral antihistamine as monotherapy 1, 2
  • Intranasal corticosteroids are more effective for nasal congestion than oral antihistamines 2
  • Second-generation oral antihistamines (like loratadine, cetirizine) are preferred over first-generation antihistamines due to less sedation 1, 2

• For moderate-to-severe allergic rhinitis or inadequate response to monotherapy:

  • Consider combination therapy with both intranasal corticosteroid and oral antihistamine 1, 2
  • This approach may be particularly beneficial for patients with prominent eye symptoms or itching 1, 2

Clinical Considerations

• The onset of therapeutic effect of intranasal corticosteroids typically occurs within 12 hours and as early as 3-4 hours in some patients 1, 2
• Continuous use of intranasal corticosteroids is generally more effective than as-needed use 1, 2
• When using intranasal corticosteroids, ensure proper technique - direct spray away from the nasal septum to minimize local side effects 1
• Intranasal corticosteroids when given in recommended doses are not generally associated with clinically significant systemic side effects 1

Common Pitfalls to Avoid

• Avoid first-generation antihistamines when possible due to their significant potential for sedation and performance impairment (which patients may not subjectively perceive) 1, 2
• If nasal congestion is severe when starting intranasal corticosteroids, a short course of nasal decongestant may help initially to improve delivery of the corticosteroid 1
• Avoid prolonged use (>3 days) of topical decongestants due to risk of rhinitis medicamentosa (rebound congestion) 1
• Ensure patients understand that intranasal corticosteroids work best with regular, continuous use rather than as-needed administration 1, 2

Evidence Quality and Considerations

• While the 2017 Joint Task Force on Practice Parameters recommends monotherapy with an intranasal corticosteroid as initial treatment, they acknowledge that combination therapy may be beneficial for some patients 1
• The evidence supporting combination therapy is mixed, with some studies showing additional benefit and others showing no significant advantage over intranasal corticosteroid monotherapy 1
• Patient preference, symptom pattern, and previous treatment response should guide the decision to use combination therapy 1, 2