Is Flonase (Fluticasone) Safe in Pregnancy?
Yes, fluticasone nasal spray can be safely used during pregnancy, though budesonide intranasal is preferred when initiating new therapy due to more extensive human safety data. 1, 2
Key Safety Evidence
Intranasal corticosteroids as a class, including fluticasone, have not been associated with increased risk of major malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension based on meta-analysis data. 1, 2
- Multiple studies examining intranasal fluticasone specifically have found no significant association with congenital organ malformations 3
- The FDA classifies fluticasone propionate as Pregnancy Category C, meaning animal studies showed adverse effects but there are no adequate human studies 4
- However, real-world observational data in humans has been reassuring 1, 5, 6
Clinical Recommendations
If a patient is already well-controlled on fluticasone before pregnancy, she can continue the same medication throughout pregnancy, as there is no substantial difference in safety among available intranasal corticosteroids. 2
When initiating intranasal corticosteroid therapy during pregnancy, budesonide is the preferred first choice due to its FDA Pregnancy Category B classification and more extensive human safety data. 1, 2
- Beclomethasone is also considered first-line with reassuring safety data 1, 7, 6
- Fluticasone is listed as "compatible" and "probably safe" by respiratory guidelines 1
- Mometasone is explicitly listed as safe at recommended doses alongside budesonide and fluticasone 2
Dosing Strategy
Use the lowest effective dose that adequately controls maternal symptoms. 1, 2
- Intranasal administration results in much lower systemic exposure compared to oral or inhaled corticosteroids 7
- At usual intranasal doses, corticosteroids have not been associated with increased risk of intrauterine growth restriction, preterm delivery, or low birthweight 1
Important Caveats
Do not confuse intranasal corticosteroids with oral/systemic corticosteroids, which carry different and more significant risks, especially in the first trimester. 2
- One study suggested doses >1000 µg/day of beclomethasone were associated with small risk of congenital malformation, but this applies to inhaled (not intranasal) formulations 1
- The FDA label notes that animal studies with fluticasone showed fetal toxicity at high doses, but these effects are characteristic of potent corticosteroids and occurred at doses far exceeding human intranasal exposure 4
Untreated rhinitis can significantly impact maternal quality of life and potentially worsen comorbid conditions like asthma, so do not discontinue effective therapy unnecessarily. 2
Alternative First-Line Options
If avoiding fluticasone is desired:
- Intranasal cromolyn sodium has an excellent safety profile and can be considered first-line, though its lower efficacy and frequent dosing requirements limit patient acceptance 5, 6
- Intranasal budesonide or beclomethasone are preferred intranasal corticosteroid options when initiating therapy 1, 7, 2
Breastfeeding Considerations
Fluticasone is compatible with breastfeeding, though it is unknown whether it is excreted in human breast milk. 4
- Other corticosteroids have been detected in human milk, but intranasal administration results in minimal systemic absorption 4