Flomist (Fluticasone) Nasal Spray Dosing Schedule
Adults should use Flomist nasal spray at 2 sprays per nostril once daily (200 mcg total), preferably in the morning, with regular daily use rather than as-needed administration for optimal symptom control. 1, 2
Adult Dosing Regimen
The standard adult dose is 200 mcg once daily, administered as 2 sprays (50 mcg each) in each nostril. 1, 2 This can alternatively be divided into 100 mcg twice daily (1 spray per nostril at 8 AM and 8 PM), which is equally effective. 2
- After the first few days of treatment, some patients may reduce to a maintenance dose of 100 mcg once daily (1 spray per nostril) if adequate symptom control is achieved. 2
- Maximum daily dose should not exceed 200 mcg (2 sprays per nostril). 2
Pediatric Dosing (Ages 4 and Older)
Children should start with 100 mcg once daily (1 spray per nostril). 2
- If inadequate response occurs, increase to 200 mcg daily (2 sprays per nostril once daily or 1 spray per nostril twice daily). 2
- Once control is achieved, decrease back to 100 mcg daily. 2
- Maximum dose is 200 mcg/day; fluticasone is not recommended for children under 4 years. 2
Regular vs. As-Needed Use
Regular daily use is strongly recommended over as-needed administration for maintaining optimal symptom control. 3, 1
- The onset of action may be delayed up to 12 hours, with maximal efficacy reached over days to weeks, making regular scheduled use essential. 3, 2
- For patients 12 years and older with seasonal allergic rhinitis specifically, as-needed use (not exceeding 200 mcg daily) may be considered, though greater symptom control is achieved with scheduled regular use. 2
- As-needed use has not been studied in children under 12 years or in patients with perennial allergic or nonallergic rhinitis. 2
Evidence on As-Needed Use
While one recent study showed similar symptom improvement between as-needed and regular use in perennial allergic rhinitis, the regular-use group demonstrated significantly better nasal airflow improvement. 4 However, FDA labeling and guidelines emphasize that regular use provides superior symptom control. 3, 1, 2
Timing and Administration
Use the spray at regular intervals, preferably in the morning for once-daily dosing. 3, 2
- Proper technique includes: priming before first use, shaking the bottle, blowing the nose beforehand, keeping the head upright, and breathing in gently during spraying. 3
- Individual patients experience variable time to onset and degree of symptom relief, with improvement typically evident within 12 hours to 3 days. 2, 5
Important Clinical Considerations
Do not expect immediate relief—maximum effect requires several days of consistent use. 3, 2