What is the recommended treatment for rhinitis?

Treatment of Rhinitis

Intranasal fluticasone propionate 200 mcg once daily is the recommended treatment for allergic rhinitis in adults and adolescents, with a reduced dose of 100 mcg once daily for children aged 4-11 years. 1

Mechanism and Efficacy

Fluticasone propionate is a potent synthetic corticosteroid that works through anti-inflammatory mechanisms, though symptom relief is not immediate. 1 Key pharmacological points include:

• Onset of action: Some patients experience symptom reduction within 12 hours, but maximum benefit typically requires several days of consistent use 1
• The drug decreases nasal mucosal eosinophils in 66% of patients (versus 35% with placebo) and basophils in 39% of patients (versus 28% with placebo) 1
• Fluticasone propionate is 3-5 fold more potent than dexamethasone in glucocorticoid receptor binding assays 1

Dosing Algorithm

Adults and adolescents:

• Start with 200 mcg (2 sprays per nostril) once daily 1
• Continue for at least several days to achieve maximum benefit 1

Children aged 4-11 years:

• Use 100 mcg once daily 1
• Safety and efficacy established for 2-4 week treatment periods 1

Safety Profile

The medication demonstrates excellent tolerability with minimal systemic absorption:

• Absolute bioavailability is less than 2% via intranasal route 1
• Plasma concentrations remain below detection limits (50 pg/mL) at recommended doses 1
• Less than 2% of patients discontinued treatment due to adverse events in clinical trials 1
• Most common adverse effects are local: headache (16.1%), pharyngitis (7.8%), epistaxis (6.9%), and nasal burning/irritation (3.2%) 1

Critical Drug Interaction

Avoid coadministration with ritonavir or other potent CYP3A4 inhibitors, as this dramatically increases systemic fluticasone exposure (plasma concentrations increased from undetectable to 318 pg/mL with ritonavir coadministration). 1

Important Caveats

• Systemic corticosteroid effects were not reported in controlled trials up to 6 months duration at recommended doses 1
• If recommended doses are exceeded or patients are particularly sensitive, Cushing syndrome could theoretically occur 1
• Symptoms may persist for several days after discontinuation due to the drug's prolonged anti-inflammatory effects 1