Recommended Dosage and Usage for Budesonide and Fluticasone Nasal Sprays
For allergic rhinitis, budesonide nasal spray should be used at 2 sprays per nostril twice daily (or 4 sprays per nostril in the morning), while fluticasone propionate nasal spray should be used at 2 sprays per nostril once daily for adults. 1
Budesonide (Rhinocort AQ) Dosing
- For patients ≥6 years: 2 sprays per nostril twice daily (32 μg per spray, total 128 μg daily) or 4 sprays per nostril once daily in the morning 1
- Not approved for children under 6 years of age 1
- Common side effects include epistaxis, pharyngitis, bronchospasm, coughing, and nasal irritation 1
- Contraindicated in patients with hypersensitivity to the medication or its components 1
Fluticasone Propionate (Flonase) Dosing
- For adults: 2 sprays per nostril once daily (50 μg per spray, total 200 μg daily) 2
- For children 4-11 years: 1 spray per nostril once daily (50 μg total daily) 2
- For adolescents ≥12 years: Same as adult dosing (2 sprays per nostril once daily) 2
- The same total daily dose can be divided into 1 spray per nostril twice daily 2
- Once symptoms are controlled, some adults may be able to reduce to 1 spray per nostril once daily for maintenance 2
- Common side effects include headache, pharyngitis, epistaxis, nasal burning/irritation, nausea, vomiting, asthma symptoms, and cough 1
Clinical Considerations
- Intranasal corticosteroids are considered the most effective medications for treating allergic rhinitis 3
- Budesonide aqueous nasal spray at 256 μg once daily has shown comparable or slightly better efficacy than fluticasone propionate 200 μg once daily, particularly for sneezing and runny nose symptoms during high pollen exposure 4
- Once-daily dosing of budesonide has demonstrated similar efficacy to twice-daily dosing, which may improve patient adherence 5, 6
- Regular use rather than as-needed approach is recommended to maintain optimal symptom control 3
Proper Administration Technique
- Prime the bottle before first use 3
- Shake the bottle prior to spraying 3
- Have the patient blow their nose prior to using the spray 3
- Keep the head in an upright position during administration 3
- Hold the spray in the opposite hand in relation to the nostril being treated (contralateral technique) to reduce risk of epistaxis 3
- Breathe in gently during spraying 3
- If nasal saline irrigations are recommended, perform them prior to administering the steroid spray 3
Important Cautions
- Onset of action may be delayed (12 hours) with maximal efficacy reached in days to weeks 3
- Local side effects such as nasal irritation, bleeding, and nasal septal perforation are rare and can be avoided with proper administration technique 3
- Studies with intranasal fluticasone propionate and budesonide have shown no effect on growth at recommended doses compared with placebo 3
- For patients who cannot tolerate one type of intranasal corticosteroid, switching to another formulation may be beneficial 3
Both medications are effective for allergic rhinitis, with the choice between them often depending on patient age, preference, and insurance coverage. Fluticasone is approved for younger children (≥4 years) compared to budesonide (≥6 years).