What is the fluticasone prescription for nasal congestion?

Fluticasone Propionate Nasal Spray Prescription for Nasal Congestion

Prescribe fluticasone propionate aqueous nasal spray 50 mcg per spray: 2 sprays per nostril once daily in the morning (total daily dose 200 mcg) for adults and adolescents ≥12 years, or 1 spray per nostril once daily (total daily dose 100 mcg) for children ages 4-11 years. 1

Dosing Specifications

Adults and Adolescents (≥12 years)

• Standard dose: 200 mcg once daily (2 sprays per nostril) administered in the morning 2, 1
• This once-daily regimen is as effective as 100 mcg twice daily dosing and offers better compliance 3, 4
• Onset of action typically occurs within 12 hours, with some patients experiencing relief as early as 3-4 hours 2, 5
• Full therapeutic benefit may take several days to weeks of regular use 2, 1

Children (4-11 years)

• Recommended dose: 100 mcg once daily (1 spray per nostril) administered in the morning 1, 6
• The 100 mcg dose is as effective as 200 mcg in children and does not interfere with the hypothalamic-pituitary-adrenal axis 6
• Both dosages are well tolerated with no evidence of growth suppression at recommended doses 2

Clinical Rationale

Intranasal corticosteroids are the most effective monotherapy for nasal congestion associated with allergic rhinitis and should be the first-line treatment. 2, 5 They are more effective than oral antihistamines combined with leukotriene receptor antagonists for controlling all nasal symptoms, including congestion 2, 5

Mechanism and Efficacy

• Fluticasone propionate works directly in the nasal mucosa to block multiple inflammatory mediators (histamine, prostaglandins, cytokines, leukotrienes) rather than histamine alone 1
• It provides relief for nasal congestion, rhinorrhea, sneezing, nasal itching, and associated ocular symptoms 2, 7
• Significantly reduces sinus pain and pressure symptoms compared to placebo 7

Treatment Duration and Expectations

• Maintenance therapy: Continue daily use throughout the allergy season for sustained symptom control 2, 1
• Episodic use: For patients with intermittent exposure, administration 4-8 hours before allergen exposure provides protection 2
• Advise patients that regular daily use is necessary for optimal effect, as symptom relief builds over several days 1, 4

Safety Profile

• Local side effects: Minimal, with possible nasal irritation, epistaxis (blood in nasal mucus), or nasal dryness 2, 3
• Systemic effects: No evidence of HPA axis suppression at recommended doses in adults or children 3, 6, 4
• Dysgeusia: Not typically reported with fluticasone propionate monotherapy (more common with combination products containing azelastine) 2
• Nasal septal perforation is rarely reported with long-term use 2

Contraindications and Precautions

Do not prescribe if: 1

• History of allergic reaction to fluticasone propionate or any ingredients
• Current use of ritonavir (HIV medication) - consult before prescribing
• Current use of ketoconazole pills - consult before prescribing
• Already using other steroid medications for asthma, allergies, or other conditions - consult before prescribing

Not indicated for: 1

• Asthma treatment (requires separate asthma medication)
• Common cold symptoms (use only for allergic rhinitis)

Combination Therapy Considerations

For moderate-to-severe symptoms unresponsive to monotherapy: Consider adding intranasal antihistamine (azelastine 137 mcg, 1-2 sprays per nostril twice daily) to the fluticasone regimen 2

• The combination of fluticasone propionate 200 mcg plus azelastine 548 mcg provides clinically meaningful additional symptom reduction compared to either agent alone 2
• This is a weak recommendation due to concerns about study bias and increased potential for adverse effects (primarily dysgeusia) 2

Do not routinely combine with oral antihistamines as first-line therapy, since intranasal corticosteroid monotherapy is more effective 2

Common Pitfalls to Avoid

• Inadequate trial duration: Patients may discontinue prematurely before full effect is achieved; counsel on expected timeline for symptom relief 1, 4
• Irregular use: Emphasize daily administration for maintenance therapy rather than PRN use, though PRN dosing >50% of days can be effective for seasonal allergic rhinitis 2
• Incorrect administration technique: Provide proper instruction on nasal spray technique to ensure adequate drug delivery 2
• Expecting immediate relief: Unlike topical decongestants, fluticasone requires consistent use over days for maximum benefit 5, 1