Is Flonase (Fluticasone) Safe During Pregnancy?
Yes, Flonase (fluticasone propionate) intranasal spray is safe to use during pregnancy at recommended doses, and if you are already using it effectively before pregnancy, you should continue it without interruption. 1
First-Line Recommendation for Continuing Therapy
If you are already using Flonase before pregnancy and it effectively controls your symptoms, continue your current regimen — there is no substantial difference in safety among available intranasal corticosteroids, and discontinuing effective therapy unnecessarily can significantly impact maternal quality of life. 1
All modern nasal corticosteroids including fluticasone, budesonide, and mometasone should be safe at recommended doses during pregnancy. 2
Starting New Therapy During Pregnancy
If initiating nasal corticosteroid therapy for the first time during pregnancy, intranasal budesonide is the preferred first choice due to its FDA Pregnancy Category B classification based on extensive human safety data. 1
However, fluticasone propionate remains a safe alternative when budesonide is not available or if other clinical factors favor its use. 2, 1
Safety Evidence
A meta-analysis found no increased risk of major malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension with intranasal corticosteroid use during pregnancy. 1
Multiple studies examining fluticasone propionate specifically have not demonstrated teratogenic effects or adverse pregnancy outcomes at therapeutic intranasal doses. 3, 4
The FDA label notes that fluticasone propionate is Pregnancy Category C, meaning animal studies showed fetal effects at high subcutaneous doses (including cleft palate and growth retardation), but these were at systemic exposures far exceeding intranasal use. 5
Critical Distinction: Intranasal vs. Oral Corticosteroids
Do not confuse intranasal corticosteroids with oral corticosteroids — oral corticosteroids carry different and more significant risks, especially in the first trimester, including slightly increased risk for cleft lip/palate, preeclampsia, and preterm delivery. 2, 1
Intranasal formulations have minimal systemic absorption and do not carry these same risks. 3, 4
Dosing Strategy
Use the lowest effective dose that adequately controls maternal symptoms. 1
Standard recommended doses for Flonase (typically 1-2 sprays per nostril daily, maximum 200 mcg/day) are well within safe limits. 2, 5
Clinical Considerations
Consult with the patient's obstetrician when initiating therapy, particularly for complex cases, though this should not delay treatment of symptomatic rhinitis. 1
Untreated rhinitis can worsen comorbid conditions like asthma, which poses greater maternal-fetal risks than the intranasal corticosteroid itself. 1
One small randomized controlled trial (n=53) of fluticasone propionate in pregnancy rhinitis showed no detectable influence on maternal cortisol, fetal growth measures, or pregnancy outcomes, though it also showed limited efficacy for pregnancy rhinitis specifically. 6
Breastfeeding
While it is unknown whether fluticasone propionate is excreted in human breast milk, the minimal systemic absorption from intranasal use makes clinically significant transfer unlikely. 5
Other corticosteroids have been detected in breast milk, so caution is advised, but intranasal use should not preclude breastfeeding. 5
What to Avoid
Avoid unnecessarily high doses (>200 mcg/day for fluticasone propionate intranasal). 5
Avoid switching from an effective regimen to an unfamiliar medication solely due to pregnancy concerns. 1
Avoid intranasal antihistamines and first-generation oral antihistamines as first-line agents, though second-generation antihistamines like cetirizine and loratadine are safe alternatives if corticosteroids are insufficient. 7