From the FDA Drug Label
The following incidence of common adverse reactions (>3%, where incidence in fluticasone propionate-treated subjects exceeded placebo) is based upon 7 controlled clinical trials... Epistaxis5.46.06.9 Other adverse events that occurred in ≤3% but ≥1% of patients and that were more common with fluticasone propionate (with uncertain relationship to treatment) included: blood in nasal mucus...
The FDA drug label does not provide direct evidence that Flonase (fluticasone) nasal spray helps with epistaxis. In fact, epistaxis is listed as an adverse reaction with an incidence of 5.4-6.9% in patients treated with fluticasone propionate. Additionally, blood in nasal mucus is also reported as an adverse event. Therefore, Flonase may actually be associated with an increased risk of epistaxis, rather than providing a benefit in treating or preventing it 1.
From the Research
Epistaxis and Flonase (Fluticasone) Nasal Spray
- Fluticasone propionate, the active ingredient in Flonase, is a topical anti-inflammatory corticosteroid used to treat allergic rhinitis 2.
- While Flonase is effective in treating nasal congestion, itching, rhinorrhea, and sneezing, it may also cause epistaxis as a side effect in 5-10% of patients 3.
- A systematic review and meta-analysis found that intranasal corticosteroids, including fluticasone propionate, are associated with an increased risk of epistaxis, with a relative risk of 1.48 (95% CI, 1.32-1.67) 4.
- Fluticasone propionate was found to be more effective and have a faster onset of action than placebo in treating rhinitis medicamentosa, but it may also cause epistaxis as a side effect 5.
Reducing Epistaxis Risk
- The risk of epistaxis may be reduced by using proper spray technique, as patients who used their ipsilateral hand to apply the intranasal steroid spray were more likely to develop epistaxis and have poor compliance 6.
- Patients who experience epistaxis or other side effects while using Flonase should consult their healthcare provider for alternative treatment options or guidance on proper spray technique 4, 6.
Treatment of Allergic Rhinitis
- Fluticasone propionate is a commonly used treatment for allergic rhinitis, and its efficacy has been demonstrated in several studies 3, 4, 5, 2.
- The medication is generally well-tolerated, but patients should be aware of the potential for epistaxis and other side effects, and take steps to minimize their risk 3, 4, 6.