What is the recommended dosage and usage of Flonase (fluticasone propionate) for allergic rhinitis?

Recommended Dosage and Usage of Flonase (Fluticasone Propionate) for Allergic Rhinitis

For allergic rhinitis, Flonase (fluticasone propionate) 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): 200 mcg total daily dose, administered as either:

  • 2 sprays (50 mcg per spray) in each nostril once daily (preferred regimen) 1, 2
  • 1 spray in each nostril twice daily (alternative regimen) 2

• Children (4-11 years): 100 mcg total daily dose

  • 1 spray in each nostril once daily 1, 2
  • May increase to 2 sprays in each nostril once daily (200 mcg total) only if inadequate response to initial dose 2

• Children under 4 years: Fluticasone propionate is not FDA approved for this age group 1

Administration Instructions

• Prime the bottle before first use 3
• Shake the bottle prior to each use 3
• Have patient blow their nose before using the spray 3
• Keep head in upright position during administration 3
• Direct spray away from the nasal septum to minimize irritation 4
• Breathe in gently during spraying 3

Treatment Duration and Expectations

• Onset of action may begin within 12 hours, but maximum effect may take several days 2
• Regular scheduled use is more effective than as-needed use 2
• For seasonal allergic rhinitis in patients ≥12 years, as-needed use (not exceeding 200 mcg daily) may be effective for symptom control 2
• Once adequate control is achieved in pediatric patients, the dosage should be decreased to 100 mcg daily 2

Side Effects and Precautions

• Common side effects include:

  • Headache, pharyngitis, epistaxis (nose bleeds) 1, 2
  • Nasal burning or irritation 1, 2
  • Nausea, vomiting, cough 1

• Important precautions:

  • Examine the nasal septum periodically to ensure no mucosal erosions 4
  • Contraindicated in patients with hypersensitivity to fluticasone or its components 1
  • Use at the lowest effective dose in children to minimize potential systemic effects 4

Efficacy Considerations

• Intranasal corticosteroids are typically the most effective medication class for controlling all four major symptoms of allergic rhinitis: sneezing, itching, rhinorrhea, and nasal congestion 4, 3
• Fluticasone propionate at 200 mcg once daily has been shown to be as effective as twice-daily dosing regimens 5
• Studies have demonstrated that fluticasone propionate is effective for both seasonal and perennial allergic rhinitis 2, 5

Alternative Options

• If intranasal steroids are not tolerated, second-generation oral or intranasal antihistamines may be considered, though they are less effective for nasal congestion 4, 3
• Intranasal cromolyn sodium is another option with a strong safety profile, though less effective than intranasal corticosteroids 3

Remember that exceeding the recommended dose does not provide additional benefit 2 and proper administration technique is crucial for maximizing efficacy and minimizing side effects 3.