Can Flonase Increase Heart Rate?
Flonase (fluticasone propionate) does not typically cause tachycardia or increase heart rate when used as directed for intranasal allergic rhinitis, as it has negligible systemic absorption and virtually zero oral bioavailability. 1
Pharmacokinetic Basis for Cardiovascular Safety
- Fluticasone propionate is rapidly cleared by hepatic metabolism with an extraction ratio approaching unity, resulting in virtually zero oral systemic bioavailability 1
- The principal metabolite (17-carboxylic acid derivative) has negligible glucocorticoid activity and does not produce systemic effects 1
- When used intranasally at recommended doses (200 mcg once daily), systemic absorption is minimal and does not produce measurable cardiovascular effects 2
Evidence Regarding Cardiac Effects
However, there is one documented case report of atrial fibrillation associated with inhaled fluticasone propionate in a 15-year-old patient, which resolved after discontinuation 3. This represents an extremely rare occurrence and involved inhaled (not intranasal) administration at high doses.
- The case report used the Naranjo adverse-drug-reaction probability scale and indicated only a "possible" relationship between fluticasone and the arrhythmia 3
- This was the first and only reported case of AF induced by inhaled corticosteroids in the literature as of 2010 3
- The mechanism is unclear, as fluticasone's minimal systemic effects at therapeutic doses make direct cardiac effects unlikely 1
Distinction Between Intranasal and High-Dose Inhaled Use
- Standard intranasal Flonase doses (200 mcg/day) produce no demonstrable systemic side-effects 1
- High-dose inhaled fluticasone (>500 mcg/day for prolonged periods) can produce systemic effects including HPA axis suppression, but cardiovascular effects remain extremely rare 4
- Studies of fluticasone/salmeterol combinations show that cardiovascular changes (heart rate, blood pressure, ECG findings) are infrequent and similar to fluticasone alone 5
Clinical Context
It is important to distinguish Flonase from medications that genuinely cause tachycardia. Drugs that increase heart rate through β-adrenergic receptor activation include salbutamol, terbutaline, dobutamine, dopamine, and theophylline 6. Fluticasone propionate does not share these mechanisms.
Practical Recommendations
- Intranasal fluticasone at standard doses (200 mcg/day) can be used safely without concern for tachycardia or increased heart rate 1
- If a patient reports palpitations or tachycardia while using Flonase, investigate alternative causes including anxiety, caffeine, decongestants, or underlying cardiac conditions rather than attributing it to fluticasone 3
- Be aware that combination products containing both fluticasone and salmeterol (a long-acting β-agonist) may cause tachycardia due to the salmeterol component, not the fluticasone 7, 8
- Monitor for local side effects of intranasal fluticasone (nasal irritation, epistaxis) rather than cardiovascular effects 2