Appropriate Dosage of Flonase (Fluticasone) for Children with Allergic Rhinitis
For children with allergic rhinitis, fluticasone propionate (Flonase) should be administered at a dosage of 1 spray per nostril (50 μg per spray) once daily for children aged 4-11 years, and 2 sprays per nostril once daily for those 12 years and older. 1, 2
Age-Specific Dosing Recommendations
- Fluticasone propionate (Flonase) is FDA-approved for children ≥4 years of age at a dosage of 1 spray per nostril daily 1
- For children 12 years and older, the recommended dose is 2 sprays per nostril once daily (200 μg total daily dose) 2
- Clinical trials have demonstrated that for children 4-11 years old, 100 μg once daily (1 spray in each nostril) is as effective as 200 μg once daily (the usual adult dose) 3, 4
- Maximum total daily doses should not exceed 2 sprays in each nostril (total dose, 200 μg/day) for pediatric patients 2
Efficacy and Safety Considerations
- Intranasal corticosteroids are considered the most effective medications for treating allergic rhinitis 5
- Clinical studies have shown that fluticasone propionate is effective in reducing nasal symptoms including obstruction, rhinorrhea, sneezing, and itching in children with seasonal allergic rhinitis 3, 4
- Both 100 μg and 200 μg doses of fluticasone propionate were significantly more effective than placebo in pediatric patients, with no significant differences between the two dosages in efficacy measurements 3
- Studies have failed to demonstrate any consistent, clinically relevant effect from intranasal fluticasone on the hypothalamic-pituitary-adrenal axis in children at recommended doses 3, 6
Administration Guidelines
- Administer once daily in the morning for optimal effect 2, 4
- Individual patients will experience variable time to onset and different degrees of symptom relief 2
- Onset of action may begin as soon as 12 hours after treatment, but maximum effect may take several days 2
- For pediatric patients not adequately responding to 100 μg daily, treatment with 200 μg daily may be considered 2
- Once adequate control is achieved, the dosage should be decreased to 100 μg daily when possible 2
Common Side Effects
- Common side effects include headache, pharyngitis, epistaxis (nose bleeds), nasal burning or irritation, nausea, vomiting, asthma symptoms, and cough 1
- Local side effects such as nasal irritation, bleeding, and nasal septal perforation are rare and can be avoided with proper administration technique 5
Proper Administration Technique
- Prime the bottle before first use
- Shake the bottle prior to spraying
- Have the child blow their nose prior to using the spray
- Keep the head in an upright position during administration
- Hold the spray in the opposite hand in relation to the nostril being treated (contralateral technique reduces epistaxis risk) 5
- Instruct the child to breathe in gently during spraying 5
Alternative Options for Younger Children
- For children under 4 years (where fluticasone propionate is not approved):
- Triamcinolone acetonide (Nasacort Allergy 24HR) is approved for children ≥2 years at a dosage of 1 spray per nostril daily 1, 5
- Mometasone furoate (Nasonex) is approved for children as young as 2 years at a dosage of 1 spray per nostril daily 1, 5
- Fluticasone furoate (Veramyst) is also approved for children ≥2 years at a dosage of 1-2 sprays per nostril daily 1, 7, 8