Flonase (Fluticasone Propionate) Nasal Spray Dosing
For adults and adolescents ≥12 years, use 2 sprays per nostril once daily (200 mcg total); for children ages 4-11 years, use 1 spray per nostril once daily (100 mcg total). 1
Adult Dosing (≥12 Years)
- Start with 200 mcg daily (2 sprays per nostril once daily), which is the FDA-approved initial dose 1
- After the first few days, you may reduce to a maintenance dose of 100 mcg daily (1 spray per nostril once daily) if symptoms are controlled 1
- Alternatively, the 200 mcg dose can be divided into 100 mcg twice daily (morning and evening), which is equally effective 1, 2
- Maximum dose: Do not exceed 2 sprays per nostril daily (200 mcg total) 1
Pediatric Dosing (Ages 4-11 Years)
- Start with 100 mcg daily (1 spray per nostril once daily) 1, 3
- If inadequate response, may increase to 200 mcg daily (2 sprays per nostril once daily) 1
- Once adequate control is achieved, decrease back to 100 mcg daily for maintenance 1
- Maximum dose: Do not exceed 2 sprays per nostril daily (200 mcg total) 1
- Studies confirm that 100 mcg once daily is as effective as 200 mcg once daily in children, making the lower dose preferable 3, 4
Children Under 4 Years
- Fluticasone propionate (Flonase) is NOT FDA-approved for children under 4 years of age 1
- For children ages 2-3 years requiring intranasal steroid therapy, consider fluticasone furoate (Veramyst) instead, which is approved for ages ≥2 years at 1-2 sprays per nostril daily 5
Timing and Administration
- Administer once daily in the morning for optimal effect 1, 2
- Use at regular intervals, not as-needed, for best symptom control 6
- Onset of action is delayed (approximately 12 hours), with maximal efficacy reached over days to weeks 6
- Prime the bottle before first use and shake before each spray 6
Important Clinical Considerations
- Both seasonal and perennial allergic rhinitis respond to the same dosing regimen 2, 4
- Once-daily dosing is as effective as twice-daily dosing for perennial allergic rhinitis 2
- The medication does not suppress the hypothalamic-pituitary-adrenal axis at recommended doses, even in children 3
- Common side effects include headache, pharyngitis, epistaxis, and nasal burning/irritation 5, 6