Flonase (Fluticasone Propionate) Nasal Spray Dosing
For adults and adolescents ≥12 years, start with 2 sprays (50 mcg each) in each nostril once daily (total 200 mcg/day), and for children ages 4-11 years, use 1 spray in each nostril once daily (100 mcg/day). 1
Adult Dosing (≥12 years)
- Initial dose: 2 sprays per nostril once daily (200 mcg total daily dose) 1
- Alternative regimen: The same 200 mcg dose can be divided into 100 mcg twice daily (e.g., 8 a.m. and 8 p.m.), which is equally effective 1
- Maintenance dose: After the first few days, reduce to 1 spray per nostril once daily (100 mcg total) if adequate symptom control is achieved 1
- For seasonal allergic rhinitis specifically, as-needed use of 200 mcg once daily may be effective, though scheduled regular use provides greater symptom control 1
Pediatric Dosing (Ages 4-11 years)
- Start with 1 spray per nostril once daily (100 mcg total) 1
- If inadequate response: May increase to 2 sprays per nostril once daily (200 mcg total) 1
- Once adequate control is achieved, decrease back to 1 spray per nostril daily 1
- Maximum dose: Do not exceed 2 sprays per nostril daily (200 mcg/day) 1
- Fluticasone propionate is not recommended for children under 4 years of age 1
Clinical Evidence Supporting Dosing
- In children ages 4-11 years with seasonal allergic rhinitis, 100 mcg once daily is as effective as 200 mcg once daily for symptom control, with no significant differences in efficacy measurements 2
- For perennial allergic rhinitis in adults, 200 mcg once daily is as effective as 100 mcg twice daily, with both regimens maintaining symptom control throughout 6 months of treatment 3
Important Administration Considerations
- Prime the bottle before first use and shake before each spray 4
- Have patients blow their nose prior to administration 4
- Keep head upright during administration and breathe in gently during spraying 4
- Use contralateral hand technique (hold spray in opposite hand from nostril being treated) to direct spray away from nasal septum—this reduces epistaxis risk by four times 5
- If using nasal saline irrigations, perform them before administering fluticasone to avoid rinsing out the medication 5
Onset and Duration of Effect
- Onset of action is delayed approximately 12 hours, with maximal efficacy reached in days to weeks 4
- Patients must be counseled to continue therapy for at least 2 weeks after initiation, as full benefit may not be evident during this period 5
- Regular scheduled use is more effective than as-needed use for maintaining optimal symptom control 4, 6
Common Side Effects
- Headache, pharyngitis, epistaxis (nose bleeds), and nasal burning or irritation are the most common adverse effects 4, 6
- Nausea, vomiting, asthma symptoms, and cough may also occur 4
- The most frequent adverse event with long-term use is epistaxis, which can be minimized with proper spray technique 5
Contraindications
- Hypersensitivity to fluticasone propionate or any component of the formulation 4
Key Clinical Pitfall to Avoid
Do not discontinue therapy when symptoms improve—fluticasone is maintenance therapy, not rescue therapy like decongestants, and requires continuous use for sustained benefit 5